Key result
Percutaneous balloon mitral valvuloplasty improved LA/LAA function, with a mitral annular Sa velocity cutoff of 5.5 cm/s and LAAEV cutoff of 25 cm/sec predicting an inactive LAA.
Why the study?
LA/LAA dysfunction causes blood stasis, thromboembolic events, and heart failure in severe mitral stenosis; the study aimed to evaluate the impact of PBMV on LA/LAA function and identify predictors of improvement.
Does percutaneous balloon mitral valvuloplasty improve left atrial and left atrial appendage function in patients with severe mitral stenosis?
Observational (n=50)
No
Does percutaneous balloon mitral valvuloplasty improve left atrial and left atrial appendage function in patients with severe mitral stenosis?
PBMV improves left atrial and appendage function in severe mitral stenosis, with specific echocardiographic cutoffs (Sa velocity 5.5 cm/s, LAAEV 25 cm/s) predicting LAA inactivity.
Sa velocity and SEC may predict LA recovery after PBMV; hypothesis-generating, needs larger trials before practice change.
LA/LAA dysfunction is a serious concern in patients with severe mitral stenosis, which may lead to blood stasis and thromboembolic consequences, as well as heart failure. In this research, we aimed to examine the impact of PBMV on LA/LAA function, specifically focusing on mitral annulus Sa velocity, SEC grade and LAA TDI parameters, in order to identify the determinants of improved LA/LAA function. Methods: Preliminary research was undertaken between June 2020 and April 2022 at a Tertiary Care Hospital in the United States. At the National Heart Institute's Cardiology Department, a total of 50 patients with symptomatic, isolated, severe mitral stenosis underwent PBMV surgery. Dyspnea was a common symptom in more than half of our patients, most of whom were in their 30s and 40s (NYHA class II). An improved LA/LAA SEC grade, decreased mitral valve diastolic pressure gradient and decreased diastolic left atrial diameter were all seen following PBMV. After PBMV, mitral annular Sa velocity, LAAEV, and LAAFV were all significantly improved. " We also found that improvement in LA/LAA function after PBMV was significantly predicted by mitral annular Sa velocity. The SEC grade of the LA/LAA was shown to be a major predictor of improvement in LA/LAA function following PBMV. Our findings showed that the mital annular Sa velocity cutoff value was 5.5 cm/s was the ideal speed for predicting an inactive LAA. The cutoff value for LAAEV in our investigation was 25 cm/sec for the prediction of inactive LA/LAA. Conclusion: Pre-PBMV inactivity was predicted by lower Sa-wave velocity; after PBMV inactivity was predicted by higher Sa-wave velocity, higher LAAEV, lower SEC grade, lower left atrial diameter, larger MVA and lower PASP. Specifically, lower left atrial diameter, larger MVA and lower PASP were associated with improved LA function after PBMV.
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Abdelfattah et al. (2022) conducted an observational in Symptomatic, isolated, severe mitral stenosis (n=50). Percutaneous balloon mitral valvuloplasty (PBMV) vs. Pre-procedure baseline was evaluated on Improvement in LA/LAA function (mitral annular Sa velocity, SEC grade, and LAA TDI parameters). Percutaneous balloon mitral valvuloplasty improved LA/LAA function, with a mitral annular Sa velocity cutoff of 5.5 cm/s and LAAEV cutoff of 25 cm/sec predicting an inactive LAA.
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