Selecting the optimal candidates for percutaneous mitral valvuloplasty using multi-modality imaging

Abstract

Aims: This study compared echocardiography (echo) and cardiac computed tomography (CT) in measuring the Wilkins score and evaluated the potential added benefit of CT in predicting immediate percutaneous mitral valvuloplasty (PMV) outcomes in rheumatic mitral stenosis (MS) patients deemed eligible for PMV by echo.

Methods and results: From a multicentre registry of 3,140 patients with at least moderate MS, we included 96 patients (age 56.4 ± 11.5 years, 81% female) eligible for PMV based on echo Wilkins score (≤9) who underwent PMV and had measurable CT and echo images. We compared Wilkins scores from both modalities and analysed their relationship with unsuccessful procedural outcomes, defined as sub-optimal post-procedural mitral valve area (<1.5 cm2) or newly developed mitral regurgitation Grade ≥III. The mean CT score was higher than the echo score (8.0 ± 2.4 vs. 7.3 ± 1.2 points, P = 0.005). Procedural success was achieved in 65 (67.7%) patients. Unsuccessful results occurred in 31 patients, primarily in intermediate echo score (7-9 points) group. Among patients with intermediate echo scores, 90% had high CT scores (≥9), which were associated with significantly higher rates of unsuccessful PMV compared with lower CT scores (61.1 vs. 18.9%, P < 0.001).

Conclusion: CT-derived Wilkins scores were higher than echo-derived scores, with the most significant discrepancy in the intermediate echo score group. CT identified a subgroup of patients at higher risk for unsuccessful PMV among those with intermediate echo-based feasibility. Patients with intermediate echo-based PMV feasibility may benefit from CT-based reclassification, potentially improving patient selection and procedural outcomes.