Rheumatic Mitral Stenosis: Correlation Between Mitral Valve Area and Hemodynamic and Echocardiographic Parameters

Document Type : Original Article

Authors

1 Nobel Medical College Teaching Hospital, Biratnagar, Nepal.

2 Koshi Zonal Hospital, Biratnagar, Nepal.

Abstract

Background: The relationship between mitral valve area (MVA) and different hemodynamic and echocardiographic parameters is not well defined. This study aimed to assess whether hemodynamic and echocardiographic parameters correlated with MVA in patients with rheumatic mitral stenosis.
Methods: This cross-sectional study assessed 600 patients with rheumatic heart disease who underwent transthoracic echocardiography in a tertiary care center between August 2018 and March 2020. Among them, 265 cases of predominant mitral stenosis were enrolled. Demographic data, as well as hemodynamic and echocardiographic variables, were recorded.
Results: Out of the 265 patients, 29.1% were males, and 71.9% were females at a mean age of 44.80±13.54 years. MVA ranged between 0.5 cm2 and 2.0 cm2, with a mean mitral valve gradient of 10.02±3.43 mm Hg. Atrial fibrillation was present in 44.2%. There were positive correlations between MVA and body mass index (r=0.19, P=0.002), systolic blood pressure (r=0.14, P=0.011), diastolic blood pressure (r=0.16, P=0.006), and mean blood pressure (r=0.18, P=0.003). Negative correlations were found between MVA and heart rate (r= −0.20, P=0.001), left atrial size (r= −0.16, P=0.007), mean mitral valve gradient (r= −0.67, P<0.001), and pulmonary artery systolic pressure (r= −0.17, P=0.004).
Conclusions: MVA correlated significantly with body mass index, blood pressure, heart rate, left atrial size, mean mitral valve gradient, and pulmonary artery systolic pressure. This study helps to understand the influence of different clinical parameters and transthoracic echocardiographic findings to accurately assess rheumatic mitral stenosis severity. (Iranian Heart Journal 2022; 23(2): 6-15)

Keywords


  1. Wunderlich NC, Beigel R, Siegel RJ. Management of mitral stenosis using 2D and 3D echo-Doppler imaging. JACC Cardiovasc Imaging. 2013Nov; 6(11):1191-205. DOI: 10.1016/j.jcmg.2013.07.008.
  2. Rheumatic fever and rheumatic heart disease. Report of a WHO Expert Consultation. World Health Organization, Geneva, 2001 (Technical Report Series No. 923).
  3. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63(22):2438-88. https://doi.org/10.1016/j.jacc.2014.02.537.
  4. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28:1-39. https://doi.org/10.1016/j.echo.2014.10.003.
  5. Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence, and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single-center experience. Indian Heart J. 2014 May-Jun; 66(3):320-6. doi:10.1016/j.ihj.2014.03.010. Epub 2014 Apr 14. PMID: 24973838
  6. Movahed MR, Ahmadi-Kashani M, Kasravi B, Saito Y. Increased prevalence of mitral stenosis in women. J Am Soc Echocardiogr. 2006; 19:911-913. https://doi.org/10.1016/j.echo.2006.01.017.
  7. Negi PC, Sondhi S, Rana V, Rathore S, Kumar R, Kolte N, et al. Prevalence, risk determinants, and consequences of atrial fibrillation in rheumatic heart disease: 6 years hospital based-Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry. Indian Heart J. 2018 Dec; 70 Suppl 3(Suppl 3): S68-S73. doi: 10.1016/j.ihj.2018.05.013.
  8. Pourafkari L, Ghaffari S, Bancroft GR, Tajlil A, Nader ND. Factors associated with atrial fibrillation in rheumatic mitral stenosis. Asian Cardiovascular and Thoracic Annals, 2015; 23(1),17–23. https://doi.org/10.1177/0218492314530134, PMID: 24696100
  9. Kim HJ, Cho GY, Kim YJ. Development of atrial fibrillation in patients with rheumatic mitral valve disease in sinus rhythm. Int J Cardiovasc Imaging. 2015; 31(4):735-42. doi:10.1007/s10554-015-0613-2.
  10. Faletra F, Pezzano A Jr, Fusco R, Mantero A, Corno R, Crivellaro W, et al. Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices. J Am Coll Cardiol. 1996; 28:1190-7.
  11. Nishimura RA, Rihal CS, Tajik AJ, Holmes DR Jr. Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol. 1994; 24:152-8.
  12. Lloyd G, Badiani S, Costa M, Armado K, Bhattacharyya S. Mitral stenosis in 2019: changing approaches for changing times, Expert Review of Cardiovascular Therapy. 2019; 17(7): 473-77. DOI:10.1080/14779072.2019.1632190
  13. Arı H, Arı S, Karakuş A, Camcı S, Doğanay K, Tütüncü A, et al. The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis. Anatol J Cardiol. 2017 Aug; 18(2):90-98. DOI:10.14744/AnatolJCardiol.2017.7614,
  14. Bassan R, Rocha AS, Baldwin BJ. Hemodynamic profile of mitral stenosis. Correlation with valve area. Arq Bras Cardiol. 1986; 47(1):41‐48.
  15. Neema PK, Rathod RC. Pulmonary artery hypertension in mitral stenosis: Role of right ventricular stroke volume, atrioventricular compliance, and pulmonary venous compliance. J Anaesthesiol Clin Pharmacol. 2012 Apr; 28(2):261-2. DOI: 10.4103/0970-9185.94916.
  16. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994; 89(2):724‐730. DOI:10.1161/01.cir.89.2.724
  17. Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997; 96(7):2455‐2461. DOI:10.1161/01.cir.96.7.2455