Updated Wilkins Score Predicting Success of Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis.

Figures

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  Figure 1. Flow of the Study Patients A total of 1,282 patients with rheumatic mitral stenosis (MS) underwent percutaneous balloon mitral valvuloplasty (PBMV) using either Inoue or Accura balloons across 4 hospitals. Of these, 154 patients were excluded because of missing information on procedural success, resulting in 1,128 patients included in the final analysis. †Patients may have had more than 1 missing data element.

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  Figure 2. Classification Plots Classification plots illustrating the proportions of true positive and false positive classifications across decision thresholds for the Wilkins score (A) and the Wilkins-Integrated Clinical percutaneous balloon mitral valvuloplasty score (B). Compared with the Wilkins score, the integrated clinical score demonstrates improved separation between true positive and false positive probabilities across thresholds, indicating enhanced discriminative performance.

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  Figure 3. Calibration Plots Calibration plots depicting the agreement between predicted and observed probabilities of PBMV success for the Wilkins score (A) and the Wilkins-Integrated Clinical PBMV score (B). Patients were grouped according to similar predicted probabilities, and the mean predicted risk for each group was plotted against the observed PBMV success rate with 95% CIs. Triangular markers represent grouped patient observations. Solid black lines represent smoothed calibration curves; shaded areas indicate 95% CIs; and the diagonal red line indicates perfect calibration. Compared with the Wilkins score, the integrated clinical model demonstrates closer agreement between predicted and observed success rates, indicating improved calibration and risk estimation. The lower histogram displays the distribution of predicted probabilities, stratified by procedural outcome (success = 1; failure = 0). Abbreviation as in Figure 1.

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  Figure 4. Decision Curve Analysis This figure presents decision curve analysis comparing the clinical utility of the Wilkins score and the Wilkins-Integrated Clinical PBMV score for predicting PBMV success across a range of high-risk thresholds. Standardized net benefit is plotted against the risk threshold. The integrated clinical model demonstrates a higher net benefit than the Wilkins score alone over clinically relevant thresholds, indicating improved clinical usefulness for decision making. Reference strategies of treating all patients (“All”) or none (“None”) are shown for comparison. Abbreviation as in Figure 1.

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  Figure 5. Wilkins-Integrated Clinical PBMV Score to Predict PBMV Success This figure displays the multivariable logistic regression formula used to derive the Wilkins-Integrated Clinical PBMV score for predicting PBMV success. Regression coefficients for anatomical Wilkins score components and selected clinical variables were estimated from the development cohort and combined to calculate the predicted probability of procedural success. logit(P) denotes the log-odds of PBMV success; exp indicates the exponential function; Yes = 1 and No = 0 for binary variables. AF = atrial fibrillation; FCIV = NYHA functional class IV; MVApre = preprocedural mitral valve area; RVSP = right ventricular systolic pressure; severeTR = severe tricuspid regurgitation; other abbreviation as in Figure 1.

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  Central Illustration. The Wilkins-Integrated Clinical Percutaneous Balloon Mitral Valvuloplasty Score to Predict Percutaneous Balloon Mitral Valvuloplasty Success Summarized is the development and performance of the Wilkins-Integrated Clinical PBMV score for predicting procedural success in patients with rheumatic MS undergoing PBMV. In a multicenter cohort of 1,128 patients, anatomical Wilkins score components were integrated with key clinical variables using a multivariable logistic regression model. This approach highlights the added value of combining anatomical and clinical factors to provide a more comprehensive and individualized assessment of PBMV success using routinely available preprocedural data. AF = atrial fibrillation; MVA = mitral valve area; MS = mitral stenosis; PBMV = percutaneous balloon mitral valvuloplasty; RVSP = right ventricular systolic pressure; TR = tricuspid regurgitation.