Key result
PBMV linked to improved LV function and ~30% lower MPI at 3 months vs baseline.
Why the study?
Patients with rheumatic mitral stenosis and normal LV EF have ventricular dysfunction that can be assessed by tissue Doppler velocity, but the effect of PBMV on LV function is not well defined.
Does percutaneous balloon mitral valvuloplasty improve left ventricular function in patients with severe rheumatic mitral stenosis and normal LVEF?
Observational (n=52)
No
Does percutaneous balloon mitral valvuloplasty improve left ventricular function in patients with severe rheumatic mitral stenosis and normal LVEF?
Absolute Event Rate: 0.38% vs 0.54%
p-value: p=0.01
Percutaneous balloon mitral valvuloplasty significantly improves subclinical left ventricular longitudinal dysfunction in patients with severe rheumatic mitral stenosis and normal ejection fraction.
Was associated with improved LV function in severe rheumatic MS with normal EF; hypothesis-generating and requires randomized confirmation.
Objective: Patients with rheumatic mitral stenosis, despite having normal left ventricular ejection fraction (LV EF), have ventricular dysfunction in the form of impaired longitudinal excursion.Tissue Doppler velocity is a useful indicator for assessment of long-axis ventricular shortening and lengthening.The aim of our study was to evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on LV function in rheumatic MS and to study echocardiographic parameters with M-Mode and Tissue Doppler Imaging pre PBMV, post PBMV and on follow-up to determine predictors of LV function.Methods: We analysed 52 patients with severe mitral stenosis with normal LV EF, who underwent PBMV at our institute.Baseline parameters of LV function were compared with immediate post PBMV and at three months follow up.Results: The mean age of the patients was 33.73 (10.87) years with female preponderance.The mean mitral valve area before PBMV was 0.92 (0.13) cm 2 which increased to 1.65 (0.21) cm 2 after PBMV and at 3 month it was 1.61 (0.23) cm 2 (p<0.001).LVEF before PBMV by modified Simpson's method was 55.45 (8.44)% and after PBMV, it was 55.58 (3.46)% and at 3 month it was 56.62 (2.46)% (p>0.05).Mitral valve E' was 8.71 (1.54) cm/s which increased to 10.13 (1.68) cm/s post PBMV and at 3 month it was 10.83 (1.34) cm/s (p<0.001).. Mitral annular systolic velocity (MASV), before PBMV was 7.90 (0.96) cm/s which increased to 9.31 (1.68) cm/s after PBMV and at 3 month it was 10.13 (0.96) cm/s (p<0.001).Myocardial performance index (MPI) before PBMV was 0.54 (0.48) which decreased post PBMV to 0.47 (0.06) and at 3 month it was 0.38 (0.04) (p=0.01).Pre PBMV MPI value <0.48 predicted improvement in LV function (sensitivity: 81%, specificity: 58.1%).Conclusion: Thus, PBMV leads to improvement in LV function in patients with severe MS with normal LV EF.
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Singh et al. (2022) conducted an observational in Severe rheumatic mitral stenosis with normal left ventricular ejection fraction (n=52). Percutaneous balloon mitral valvuloplasty vs. Baseline (pre-procedure) was evaluated on Myocardial performance index (MPI) at 3 months (p=0.01). Percutaneous balloon mitral valvuloplasty significantly improved left ventricular function in patients with severe rheumatic mitral stenosis and normal ejection fraction, reducing the myocardial performance index from 0.54 at baseline to 0.38 at 3 months (p=0.01).
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