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KMID : 1146220190270020122
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Journal of Cardiovascular Imaging
2019 Volume.27 No. 2 p.122 ~ p.133
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Prognostic Implications of the Left Atrial Volume Index in Patients with Progressive Mitral Stenosis
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Cho In-Jeong
Jeong Hyeon-Ju
Choi Jah-Yeon
Lee Sang-Eun
Chang Hyuk-Jae
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Abstract
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BACKGROUND: Limited data are available on the prognosis of progressive mitral stenosis (MS). We evaluated the factors associated with adverse events in patients with progressive MS.
METHODS: We retrospectively analyzed 259 consecutive patients with pure progressive MS with a mitral valve area (MVA) between 1.5 and 2.0 cm2. The primary outcome measures were a composite endpoint of cardiac death, heart failure hospitalization, mitral valve surgery or percutaneous mitral valvuloplasty, and ischemic stroke.
RESULTS: The mean patient age was 62 ± 12 years, and the mean MVA was 1.71 ± 0.15 cm2. Over a median follow-up duration of 52 months, a total of 41 patients (18.3%) experienced the composite endpoint. In multivariable Cox regression analysis, prior stroke (hazard ratio [HR], 4.54; 95% confidence interval [CI], 2.16?9.54; p < 0.001) and left atrial volume index (LAVI) of > 50 mL/m2 (HR, 4.45; 95% CI, 1.31?15.31; p = 0.017) were identified as independent predictors of the composite endpoint, even after adjusting for age and sex. Patients with a LAVI ≤ 50 mL/m2 demonstrated favorable event-free survival compared with those with a LAVI > 50 mL/m2 in either the overall population (p < 0.001) or asymptomatic patients (p = 0.002). Atrial fibrillation (AF), left ventricular mass index (LVMI), MVA, and mean diastolic pressure were factors independently associated with LAVI (all p < 0.05).
CONCLUSIONS: A deleterious impact of a high LAVI on outcome was observed in patients with progressive MS. The LAVI was mainly influenced by the presence of AF, the severity of MS, and LVMI in this population.
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KEYWORD
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Mitral stenosis, Left atrial volume, Prognosis
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