Predicting Success and Long-Term Outcomes of Percutaneous Mitral Valvuloplasty: A Multifactorial Score
Abstract
Background
Percutaneous mitral valvuloplasty (PMV) success depends on appropriate patient selection. A multifactorial score derived from clinical, anatomic/echocardiographic, and hemodynamic variables would predict procedural success and clinical outcome.
Methods
Demographic data, echocardiographic parameters (including echocardiographic score), and procedure-related variables were recorded in 1085 consecutive PMVs. Long-term clinical follow-up (death, mitral valve replacement, redo PMV) was performed. Multivariate regression analysis of the first 800 procedures was performed to identify independent predictors of procedural success. Significant variables were formulated into a risk score and validated prospectively.
Results
Six independent predictors of PMV success were identified: age less than 55 years, New York Heart Association classes I and II, pre-PMV mitral area of 1 cm2 or greater, pre-PMV mitral regurgitation grade less than 2, echocardiographic score of 8 or greater, and male sex. A score was constructed from the arithmetic sum of variables present per patient. Procedural success rates increased incrementally with increasing score (0% for 0/6, 39.7% for 1/6, 54.4% for 2/6, 77.3% for 3/6, 85.7% for 4/6, 95% for 5/6, and 100% for 6/6; P < .001). In a validation cohort (n = 285 procedures), the multifactorial score remained a significant predictor of PMV success (P < .001). Comparison between the new score and the echocardiographic score confirmed that the new index was more sensitive and specific (P < .001). This new score also predicts long-term outcomes (P < .001).
Conclusion
Clinical, anatomic, and hemodynamic variables predict PMV success and clinical outcome and may be formulated in a scoring system that would help to identify the best candidates for PMV.
aCardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
bServicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, España
cServicio de Cardiología. Hospital Universitario de Salamanca, Salamanca, España
Requests for reprints should be addressed to Ignacio Cruz-Gonzalez, MD, PhD, Cardiac Catheterization Laboratory, Massachusetts General Hospital, GRB 800, 55 Fruit Street, Boston, MA, 02114
Funding: Dr Cruz-Gonzalez acknowledges the support and funding of the Spanish Society of Cardiology (Hemodynamic section) and Medtronic Iberia S.A. Drs Cruz-Gonzalez and Sanchez-Ledesma acknowledge the support of the University Hospital of Salamanca.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.
ABSTRACT
