Impact of preprocedural atrial fibrillation on immediate and long-term outcomes after successful percutaneous mitral val
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ORIGINAL ARTICLE
Impact of preprocedural atrial fibrillation on immediate and longterm outcomes after successful percutaneous mitral valvuloplasty of significant mitral stenosis Shiro Miura1 • Takeshi Arita2 • Takenori Domei3 • Kyohei Yamaji3 • Yoshimitsu Soga3 • Makoto Hyodo3 • Shinichi Shirai3 • Kenji Ando3
Received: 7 March 2016 / Accepted: 23 September 2016 The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We sought to identify prognostic factors and evaluate long-term clinical outcomes after PMV of 77 consecutive patients with MS with a mitral valve area (MVA) \1.5 cm2. According to baseline heart rhythm, these patients were divided into sinus rhythm (SR; n = 24) and AF (n = 53) groups. The study endpoint was defined as a composite of all-cause mortality, admission for heart failure, mitral valve surgery, repeated PMV, and major cerebral vascular accident during follow-up. After successful PMV, there was no significant difference between the two groups in post-MVA and post-mitral mean pressure gradient. However, the New York Heart Association Functional Classification post-procedure was worse in the AF group (p \ 0.01). In the AF group, event-free survival during follow-up was significantly lower compared with that of the SR group (p = 0.016). Independent predictors of clinical events were AF [hazard ratio (HR), 2.73; 95 % confidence interval (CI), 1.04–9.36; p = 0.03] and pulmonary artery systolic pressure (HR 2.57; 95 % CI 1.18–5.47; p = 0.017). Patients with AF at baseline were significantly associated with worse symptoms and higher
& Shiro Miura [email protected] 1
Department of Social, Human and Mathematical Sciences, University of Southampton, Highfield, Southampton, Hampshire SO17 1BJ, UK
2
Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
3
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
event rates after successful PMV compared with those with SR. The clinical benefit of PMV may be considered for patients with MVA \1.5 cm2 before the onset of AF. Keywords Mitral stenosis Percutaneous mitral valvuloplasty Atrial fibrillation Long-term outcome
Introduction Since its introduction in 1984 by Inoue [1], percutaneous mitral valvuloplasty (PMV), which is also well known as percutaneous transluminal mitral commissurotomy (PTMC), has been established as a safe and effective procedure for the treatment of symptomatic mitral stenosis (MS) [2–4]. The decrease in the incidence of acute rheumatic fever in developed countries led to a sharp decrease in the incidence of MS [5]. This decrease modifies clinical presentation, and MS is now encountered in patients with the characteristics as follows: advanced age, atrial fibrillation (AF), history of surgical commissurotomy, repeated PMV, and severe impairmen
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