PMID- 28780580 OWN - NLM STAT- MEDLINE DCOM- 20171204 LR - 20200215 IS - 1468-201X (Electronic) IS - 1355-6037 (Linking) VI - 103 IP - 23 DP - 2017 Dec TI - Net atrioventricular compliance is an independent predictor of cardiovascular death in mitral stenosis. PG - 1891-1898 LID - 10.1136/heartjnl-2016-310955 [doi] AB - OBJECTIVES: Rheumatic mitral stenosis (MS) is a progressive disease, and risk of death may persist despite relief of the obstruction. Net atrioventricular compliance (C(n)) modulates the overall haemodynamic burden of the MS and may be useful in predicting cardiovascular death after percutaneous mitral valvuloplasty (PMV). METHODS: A total of 427 patients (mean age 50+/-16 years, 84% female) with severe MS undergoing PMV were enrolled. Doppler-derived C(n) was estimated at baseline using a previously validated equation. The primary endpoint was late cardiovascular death, and the secondary endpoint was a composite of all-cause mortality, mitral valve (MV) replacement or repeat PMV over a median follow-up of 31 months (IQR: 7.8-49.2 months). RESULTS: At baseline, 209 patients (49%) were in New York Heart Association (NYHA) functional class III or IV. During follow-up, 49 patients died (41 cardiovascular deaths), 50 underwent MV replacement and 12 required repeat PMV, with an overall incidence of cardiac mortality and adverse events of 4.1 deaths and 11.1 events per 100 patient-years, respectively. Low baseline C(n) was a strong predictor of both cardiac death (adjusted HR 0.70, 95% CI 0.49 to 0.86) and composite endpoint (adjusted HR 0.81, 95% CI 0.67 to 0.91) after adjusting for clinical factors, baseline pulmonary artery pressure, tricuspid regurgitation severity, right ventricular function and immediate procedural haemodynamic data. The inclusion of C(n) in a model with conventional parameters resulted in improvement in 5-year cardiovascular mortality risk prediction. CONCLUSIONS: Baseline C(n) is a strong predictor of cardiovascular death in patients with MS undergoing PMV, independent of other prognostic markers of decreased survival in MS, including baseline patient characteristics and postprocedural data. C(n) assessment therefore has potential value in evaluation of cardiovascular mortality risk in the setting of MS. CI - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Nunes, Maria Carmo Pereira AU - Nunes MCP AD - Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. AD - Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Tan, Timothy C AU - Tan TC AD - Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Elmariah, Sammy AU - Elmariah S AD - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Lodi-Junqueira, Lucas AU - Lodi-Junqueira L AD - Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - Nascimento, Bruno Ramos AU - Nascimento BR AD - Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. FAU - do Lago, Rodrigo AU - do Lago R AD - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Padilha da Silva, Jose Luiz AU - Padilha da Silva JL AD - Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. FAU - Reis, Rodrigo Citton Padilha AU - Reis RCP AD - Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. FAU - Zeng, Xin AU - Zeng X AD - Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Palacios, Igor F AU - Palacios IF AD - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Hung, Judy AU - Hung J AD - Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Levine, Robert A AU - Levine RA AD - Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. LA - eng GR - R01 HL038176/HL/NHLBI NIH HHS/United States GR - R01 HL072265/HL/NHLBI NIH HHS/United States GR - R01 HL109506/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20170805 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - *Atrial Function MH - Balloon Valvuloplasty MH - Boston MH - Brazil MH - Cause of Death MH - Echocardiography, Doppler MH - Female MH - Heart Valve Prosthesis Implantation MH - *Hemodynamics MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Mitral Valve/diagnostic imaging/*physiopathology/surgery MH - Mitral Valve Stenosis/diagnostic imaging/*mortality/*physiopathology/therapy MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Rheumatic Heart Disease/diagnostic imaging/*mortality/*physiopathology/therapy MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - *Ventricular Function OTO - NOTNLM OT - Rheumatic heart disease OT - cardiovascular death OT - mitral stenosis OT - mortality OT - net atrioventricular compliance OT - percutaneous mitral valvuloplasty COIS- Competing interests: None declared. EDAT- 2017/08/07 06:00 MHDA- 2017/12/05 06:00 CRDT- 2017/08/07 06:00 PHST- 2016/12/05 00:00 [received] PHST- 2017/04/10 00:00 [revised] PHST- 2017/04/11 00:00 [accepted] PHST- 2017/08/07 06:00 [pubmed] PHST- 2017/12/05 06:00 [medline] PHST- 2017/08/07 06:00 [entrez] AID - heartjnl-2016-310955 [pii] AID - 10.1136/heartjnl-2016-310955 [doi] PST - ppublish SO - Heart. 2017 Dec;103(23):1891-1898. doi: 10.1136/heartjnl-2016-310955. Epub 2017 Aug 5.