Valvuloplasty: benefits for low-flow, low-gradient mitral stenosis are unclear

  • El Sabbagh A & al.
  • J Am Heart Assoc
  • 5 Mar 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key results

  • 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: 
    • Gradient
    • LVEDP >15 mmHg.
    • Higher ventricular stiffness. 
  • Nonpredictors included mitral valve area, baseline LA pressure. 

Study design

  • 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.

Limitations

  • Selection bias.
  • Results might not generalize to those with calcific degenerative MS.
  • Causation not determined.