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Differential Impact of Net Atrioventricular Compliance on Clinical Outcomes in Patients with Mitral Stenosis According to Cardiac Rhythm

Authors
 In-Jeong Cho  ;  Hyuk-Jae Chang  ;  Soo Yeon Lee  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Namsik Chung 
Citation
 JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, Vol.30(6) : 552-560, 2017 
Journal Title
 JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY 
ISSN
 0894-7317 
Issue Date
2017
MeSH
Causality ; Comorbidity ; Death, Sudden, Cardiac/epidemiology ; Echocardiography, Doppler* ; Female ; Heart Atria/diagnostic imaging* ; Heart Failure/diagnostic imaging ; Heart Failure/mortality* ; Heart Ventricles/diagnostic imaging* ; Humans ; Image Interpretation, Computer-Assisted* ; Male ; Middle Aged ; Mitral Valve Stenosis/diagnostic imaging* ; Mitral Valve Stenosis/mortality* ; Mitral Valve Stenosis/physiopathology ; Prognosis ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Sensitivity and Specificity ; Survival Rate ; Vascular Resistance ; Vascular Stiffness
Keywords
Cardiac rhythm ; Compliance ; Mitral valve stenosis ; Outcome assessment
Abstract
BACKGROUND: Net atrioventricular compliance (Cn), a parameter for the net compliance of the left atrium and left ventricle, is known to be a useful predictor of outcomes in patients with mitral stenosis (MS). The present study aimed to evaluate whether the impact of Cn on symptom status and clinical outcomes, as well as its contribution toward systolic pulmonary artery pressure (SPAP), differed according to cardiac rhythm. METHODS: We retrospectively reviewed patients (N = 308) with rheumatic pure MS. Doppler-derived Cn was calculated using planimetered mitral valve area and E-wave downslope of transmitral flow. The primary endpoint was defined as a composite of all-cause death, percutaneous mitral valvotomy, surgical mitral valve replacement, admission for heart failure, and stroke. RESULTS: Overall, there were 178 patients (58%) with sinus rhythm (SR) and 130 patients (42%) with atrial fibrillation (AF). In multivariable linear regression analysis, there was a significant independent association between Cn and SPAP in patients with SR (P = .014), but not in those with AF (P = .112). During a median follow-up of 38 months, 130 patients (27%) experienced the study endpoint. In multivariable Cox regression, high Cn was associated with a more favorable prognosis in patients with SR (hazard ratio = 0.83; 95% CI, 0.69-0.99; P = .038). Conversely, high Cn was not found to offset the burden of adverse clinical outcomes in those with AF (hazard ratio = 1.18; 95% CI, 0.99-1.40; P = .071). CONCLUSIONS: Cn appears to be associated with SPAP and clinical outcomes in MS patients with SR. The predictive role of Cn in patients with AF requires further clarification.
Full Text
https://www.sciencedirect.com/science/article/pii/S0894731717300184
DOI
10.1016/j.echo.2017.01.014
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Cho, In Jeong(조인정)
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160440
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