Key result
Mitral annular calcification predicts stroke in mitral stenosis, suggesting NOACs and LAAO for potential prevention.
Why the study?
What are the mechanisms, risk factors, and available therapies for stroke prevention in patients with mitral stenosis?
What are the mechanisms, risk factors, and available therapies for stroke prevention in patients with mitral stenosis?
This review highlights mitral annular calcification as an independent predictor of stroke in mitral stenosis and summarizes current pharmacological and non-pharmacological preventive strategies.
MAC may refine stroke risk stratification in mitral stenosis but should not yet change practice; leaves open efficacy of NOACs or LAAO.
Mitral stenosis (MS), a valvular heart disease, is defined by the narrowing of the mitral valve orifice. The common risk factors for stroke include mitral annular calcification (MAC), diabetes mellitus (DM), male gender, hypertension (HTN), hyperlipidemia, and obesity. Endothelial damage, hypercoagulability, and blood stasis in the left atrium promote the development of the thrombus. Among all the risk factors described, MAC is the independent predictor of stroke. The complicated mechanisms responsible for thromboembolism, predisposing factors for thromboembolism, the risk of cerebrovascular accident (CVA) in MS patients, advanced standardized assessment models for identifying those at risk for stroke, and the possible advantages and disadvantages of available therapies have all been discussed in this review article. We have also discussed newer oral anticoagulants (NOACs) like dabigatran, edoxaban, apixaban, and rivaroxaban. Non-pharmacological therapies are also highlighted such as left atrial appendage ligation and occlusion devices. We also conducted a thorough review of the literature on the efficacy and safety of various NOACs in reducing the risk of stroke.
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Islam et al. (2022) conducted a review in Mitral stenosis. NOACs and non-pharmacological therapies was evaluated. Mitral annular calcification is an independent predictor of stroke in patients with mitral stenosis, with NOACs and left atrial appendage occlusion serving as potential preventive therapies.