Why the study?
Hyperhomocysteinemia is a recognized cardiovascular risk factor, but research evaluating its impact on valve disease has been lacking.
Does preoperative hyperhomocysteinemia increase rheumatic mitral valve calcification and mid-term postoperative all-cause mortality in patients undergoing surgery for severe rheumatic mitral valve stenosis?
Does preoperative hyperhomocysteinemia increase rheumatic mitral valve calcification and mid-term postoperative all-cause mortality in patients undergoing surgery for severe rheumatic mitral valve stenosis?
Preoperative hyperhomocysteinemia is independently associated with greater rheumatic mitral valve calcification, lower mitral valve repair rates, and more than double the risk of mid-term all-cause mortality following mitral valve surgery.
Answers are grounded in this paper and cite their sources.
Should not yet alter risk assessment or prompt therapy; leaves open whether hyperhomocysteinemia contributes to rheumatic mitral calcification and survival.
Objective Hyperhomocysteinemia is a risk factor for cardiovascular disease, but its impact on valve disease is lacking in research. This study was aimed at investigating the impact of hyperhomocysteinemia on rheumatic mitral valve calcification and prognosis in patients undergoing surgery. Methods This study included 672 patients with severe rheumatic mitral valve stenosis who underwent surgery between January 2016 and December 2022. Patients were stratified by preoperative homocysteine levels. Mitral valve pathology was assessed by echocardiography and coronary CTA, with all‐cause mortality as the primary mid‐term endpoint. Results Among this surgical cohort of 672 patients with severe rheumatic mitral stenosis, 208 (31.0%) patients were identified with hyperhomocysteinemia. Imaging assessment revealed that these patients had a higher Agatston score for mitral valve calcification (37.47 vs. 17.19, p = 0.038) after adjusting baseline data. Restricted cubic splines revealed a significant dose–response relationship, with mitral valve calcification increasing progressively with higher homocysteine levels ( p < 0.001). The Kaplan–Meier survival analysis showed that patients with hyperhomocysteinemia had significantly lower mid‐term survival rates (log‐rank p = 0.004). Through univariate and multivariate COX regression analyses, it was found that hyperhomocysteinemia was an independent risk factor affecting mid‐term postoperative survival (HR, 2.257; p = 0.048). Conclusions In patients undergoing surgery for rheumatic heart disease, hyperhomocysteinemia was associated with the formation of rheumatic mitral valve calcification and increased mid‐term postoperative mortality. Trial Registration: Chinese Clinical Trial Registry identifier ChiCTR2200067151
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A 2025 study studied this question.
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