PMID- 1406834
OWN - NLM
STAT- MEDLINE
DCOM- 19921110
LR  - 20121115
IS  - 0028-4793 (Print)
IS  - 0028-4793 (Linking)
VI  - 327
IP  - 19
DP  - 1992 Nov 5
TI  - Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty.
PG  - 1329-35
AB  - BACKGROUND: Percutaneous balloon mitral valvuloplasty is known to produce 
      short-term hemodynamic and symptomatic improvement in many patients with mitral 
      stenosis. Comprehensive assessment of the clinical usefulness of balloon 
      valvuloplasty requires evaluation of patients' long-term outcomes. METHODS: We 
      performed balloon mitral valvuloplasty in 146 patients between October 1, 1985, 
      and October 1, 1991. Base-line demographic, clinical, echocardiographic, and 
      hemodynamic variables were evaluated in order to identify predictors of long-term 
      event-free survival. RESULTS: Balloon mitral valvuloplasty was completed 
      successfully in 136 (93 percent) of the patients in whom the procedure was 
      attempted; it resulted in an increase in the mean (+/- SD) mitral-valve area from 
      1.0 +/- 0.4 to 2.1 +/- 0.9 cm2 and a decrease in the mean transmitral pressure 
      gradient from 14 +/- 5 to 6 +/- 3 mm Hg (P < 0.001 for both comparisons). The 
      estimated overall five-year survival rate was 76 +/- 5 percent, and the estimated 
      five-year event-free survival rate (the percentage of patients without 
      mitral-valve replacement, repeat valvuloplasty, or death from cardiac causes) was 
      51 +/- 6 percent. According to multivariate Cox proportional-hazards analysis, 
      the independent predictors of longer event-free survival were a lower 
      mitral-valve echocardiographic score (a measure of mitral-valve deformity; range, 
      0 for a normal valve to 16 for a seriously deformed valve; P < 0.001), lower left 
      ventricular end-diastolic pressure (P = 0.001), and a lower New York Heart 
      Association (NYHA) functional class (P = 0.04). Patients with no risk factors for 
      early restenosis or only one risk factor (echocardiographic score > 8, left 
      ventricular end-diastolic pressure > 10 mm Hg, or NYHA functional class IV) had a 
      predicted five-year event-free survival rate of 60 to 84 percent, whereas 
      patients with two or three risk factors had a predicted five-year event-free 
      survival rate of only 13 to 41 percent. CONCLUSIONS: Balloon mitral valvuloplasty 
      as a treatment for selected patients with mitral stenosis has good long-term 
      results. The long-term outcome after this procedure can be predicted on the basis 
      of patients' base-line characteristics.
FAU - Cohen, D J
AU  - Cohen DJ
AD  - Charles A. Dana Research Institute, Harvard Medical School, Boston, MA.
FAU - Kuntz, R E
AU  - Kuntz RE
FAU - Gordon, S P
AU  - Gordon SP
FAU - Piana, R N
AU  - Piana RN
FAU - Safian, R D
AU  - Safian RD
FAU - McKay, R G
AU  - McKay RG
FAU - Baim, D S
AU  - Baim DS
FAU - Grossman, W
AU  - Grossman W
FAU - Diver, D J
AU  - Diver DJ
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
SB  - IM
MH  - *Catheterization
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Stenosis/mortality/physiopathology/*therapy
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Survival Rate
EDAT- 1992/11/05 00:00
MHDA- 1992/11/05 00:01
CRDT- 1992/11/05 00:00
PHST- 1992/11/05 00:00 [pubmed]
PHST- 1992/11/05 00:01 [medline]
PHST- 1992/11/05 00:00 [entrez]
AID - 10.1056/NEJM199211053271901 [doi]
PST - ppublish
SO  - N Engl J Med. 1992 Nov 5;327(19):1329-35. doi: 10.1056/NEJM199211053271901.