- Patients with low-gradient (LG) mitral stenosis (MS) experience less benefit from valvuloplasty than those with high-gradient (HG) MS.
- These patients may have low-flow (LF) or normal-flow MS.
- Symptoms in patients with LF/LG MS may be driven by arterial stiffness, ventricular-vascular uncoupling, Afib, decreased left ventricular compliance.
- Mitral gradient predicted valvuloplasty response.
Why this matters
- It has been unclear whether valvuloplasty benefits patients with LG, functionally severe MS.
- Compared with HG group, LG group's differences included:
- Higher left ventricular end-diastolic pressure (LVEDP) and
- Less abnormal mean pulmonary artery pressure, pulmonary vascular resistance, and mitral valve area.
- Compared with HG group, after valvuloplasty, LG group experienced:
- Less decrease in mitral gradient and left atrial (LA) pressure (P=.003).
- Less frequent symptom improvement, with 40% of LG group experiencing no improvement vs 18% of HG group (P=.02).
- Worse survival.
- Predictors of poor valvuloplasty response:
- LVEDP >15 mmHg.
- Higher ventricular stiffness.
- Nonpredictors included mitral valve area, baseline LA pressure.
- Cross-sectional study of patients with severe rheumatic MS undergoing balloon valvuloplasty, cardiac catheterization (n=101).
- Authors assessed clinical and echocardiographic characteristics, post-valvuloplasty outcomes.
- Funding: None disclosed.
- Selection bias.
- Results might not generalize to those with calcific degenerative MS.
- Causation not determined.