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Degenerative Mitral Stenosis Versus Rheumatic Mitral Stenosis

 Gregg S Pressman  ;  Rupesh Ranjan  ;  Dong Hyuk Park  ;  Chi Young Shim  ;  Geu-Ru Hong 
 AMERICAN JOURNAL OF CARDIOLOGY, Vol.125(10) : 1536-1542, 2020-05 
Journal Title
Issue Date
Age Factors ; Aged ; Comorbidity ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Stenosis / classification ; Mitral Valve Stenosis / diagnostic imaging ; Mitral Valve Stenosis / epidemiology ; Mitral Valve Stenosis / physiopathology* ; Republic of Korea / epidemiology ; Rheumatic Heart Disease / diagnostic imaging ; Rheumatic Heart Disease / epidemiology ; Rheumatic Heart Disease / physiopathology* ; Risk Factors ; United States / epidemiology
Mitral stenosis is classically caused by rheumatic disease (RMS). However, degenerative mitral stenosis (DMS) is increasingly encountered, particularly in developed countries with aging populations. The aim of this study was to compare clinical and echocardiographic characteristics between the 2 entities. One hundred fifteen patients with DMS were identified from an echocardiographic database in the United States and compared with 510 patients with RMS from Seoul, Korea. All subjects had a mitral valve area (MVA) ≤2.5 cm2 by continuity equation but were otherwise unselected. Patients with DMS were older and had more hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease than those with RMS. Atrial fibrillation was more common in RMS patients. Mean mitral valve gradient was slightly lower in DMS versus RMS (7.63 ± 3.67 vs 8.50 ± 4.23 mm Hg, p = 0.04) but MVA was strikingly higher in the DMS group (1.35 ± 0.41 vs 0.95 ± 0.38 cm2, p <0.0001). This appeared to be due to greater stroke volume in the DMS patients (70.4 ± 19.7 vs 55.7 ± 15.5 ml, p <0.0001). Indexed left atrial volume was greater in RMS (82.1 ± 40.3 vs 57.9 ± 21.4 ml, p <0.0001) while estimated pulmonary artery systolic pressure was greater in DMS (49.3 ± 16.5 vs 39.4 ± 13.6 mm Hg, p <0.0001). In conclusion, DMS patients are older and have more comorbidities than RMS patients. DMS presents with greater MVA relative to mean mitral valve gradient than RMS. This appears due to a higher stroke volume in DMS patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Dong Hyuk(박동혁)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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