Low-Gradient Severe Mitral Stenosis: Hemodynamic Profiles, Clinical Characteristics, and Outcomes

Journal of the American Heart Association
Abdallah El SabbaghPatricia A Pellikka

Abstract

Background Optimal management of patients with severe mitral stenosis ( MS ) and low transmitral gradient is incompletely understood. Methods and Results We examined 101 consecutive patients with severe rheumatic MS (mitral valve area ≤1.5 cm2) who underwent balloon valvuloplasty. Low gradient was defined as mean transmitral gradient <10 mm Hg and low flow as stroke volume index ≤35 mL/m2 by echocardiography. Symptoms and mortality data were collected. Systolic, diastolic, and arterial function were characterized by measuring left ventricular (LV) end-systolic elastance, LV stiffness constant (β), diastolic capacitance (predicted LV end-diastolic volume at a common LV filling pressure of 30 mm Hg), and effective arterial elastance. Low gradient (<10 mm Hg) was present in 55 patients, including low flow/low gradient in 11 and normal flow/low gradient in 44 patients, and high gradient was present in 46 patients. Participants with low-flow/low-gradient (LG) MS were older with higher rates of atrial fibrillation (64%) and subvalvular thickening, higher afterload, and decreased LV compliance with lower ejection fraction (57±10% versus 65±4% versus 63±6%, P=0.002) but similar end-systolic elastance compared with patients with normal-...Continue Reading

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Citations

Jul 11, 2020·Current Opinion in Cardiology·Basil Al-Sabeq, Mohammed A Chamsi-Pasha
Jun 15, 2019·Expert Review of Cardiovascular Therapy·Guy LloydSanjeev Bhattacharyya
Jan 7, 2021·Clinical Cardiology·In-Jeong ChoHyuk-Jae Chang
Mar 3, 2021·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Jeffrey J Silbiger
Jul 24, 2021·Journal of Veterinary Cardiology : the Official Journal of the European Society of Veterinary Cardiology·C ChompoosanJ Koch
Aug 29, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alec VahanianUNKNOWN ESC/EACTS Scientific Document Group
Aug 29, 2021·European Heart Journal·Alec VahanianUNKNOWN ESC Scientific Document Group
Dec 22, 2021·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Alec VahanianWojtek Wojakowski

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