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Abstract：
BACKGROUND: Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes.
METHODS: In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9-10, and Group III: score 11-12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC.
RESULTS: A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19-2.41, P = 0.003; and OR: 3.90, 95%CI 2.61-5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35-6.27, P = 0.007).
CONCLUSIONS: Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.
METHODS: In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9-10, and Group III: score 11-12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC.
RESULTS: A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19-2.41, P = 0.003; and OR: 3.90, 95%CI 2.61-5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35-6.27, P = 0.007).
CONCLUSIONS: Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.
摘要：
背景：经皮球囊二尖瓣成形术（PBMV）是ACC/AHAI类建议，用于治疗有症状的风湿性二尖瓣狭窄，具有合适的瓣膜形态，低于中度MR且无左心房凝块。二尖瓣再狭窄和显著的二尖瓣反流(MR)是已知的PBMV的不利结果。本研究旨在评估重度二尖瓣狭窄患者PBMV的转归以及佣金钙化（CC）对转归的影响。
方法：在这项单中心回顾性队列研究中，876例接受PBMV的患者根据他们的Wilkins评分分为三组（I组：评分≤8，II组：评分9-10，III组：评分11-12）。之前对患者进行了评估，PBMV后早期以及6个月和24个月的随访。主要临床结果定义为显着的再狭窄和/或症状性的显着MR（中度至重度和重度MR）或二尖瓣置换术（MVR）的候选人。比较有和没有CC的患者的结果。
结果：共有876名平均年龄为46.4±12.3岁的患者（81.0%为女性）根据Wilkins评分进行分类。333（38.0％）在第一组中，501人（57.2%）属于第二组，第III组42例(4.8%).175例（20.0%）患者存在CC，其中95例（54.3%）前外侧连合钙化，64例（36.6%）后内侧连合钙化，16例（9.1％）患者的两个连缝都钙化。有和没有CC的患者之间的Wilkins评分存在显着差异（P<0.001）。在早期和中期随访时，CC与较高的明显症状性MR的几率相关（OR：1.69，95CI1.19-2.41，P=0.003；OR：3.90，95CI2.61-5.83，P<0.001），但没有再狭窄（P=0.128）。在早期（II：P=0.784；III：P=0.098）和中期随访（II：P=0.216；III：P=0.227）时，威尔金斯II组和III组未显示出比I组更高的有症状MR几率。威尔金斯II组患者再狭窄的几率高于I组(OR:2.96,95CI:1.35-6.27,P=0.007)。
结论：委员会钙化（CC）是早期和中期随访PBMV后显著症状性MR（不良结局的重要决定因素）的独立预测因子。与得分≤8的I组相比，Wilkins评分较高的患者发生二尖瓣再狭窄更多。合并的Wilkins评分和CC应考虑患者对PBMV的适用性。
方法：在这项单中心回顾性队列研究中，876例接受PBMV的患者根据他们的Wilkins评分分为三组（I组：评分≤8，II组：评分9-10，III组：评分11-12）。之前对患者进行了评估，PBMV后早期以及6个月和24个月的随访。主要临床结果定义为显着的再狭窄和/或症状性的显着MR（中度至重度和重度MR）或二尖瓣置换术（MVR）的候选人。比较有和没有CC的患者的结果。
结果：共有876名平均年龄为46.4±12.3岁的患者（81.0%为女性）根据Wilkins评分进行分类。333（38.0％）在第一组中，501人（57.2%）属于第二组，第III组42例(4.8%).175例（20.0%）患者存在CC，其中95例（54.3%）前外侧连合钙化，64例（36.6%）后内侧连合钙化，16例（9.1％）患者的两个连缝都钙化。有和没有CC的患者之间的Wilkins评分存在显着差异（P<0.001）。在早期和中期随访时，CC与较高的明显症状性MR的几率相关（OR：1.69，95CI1.19-2.41，P=0.003；OR：3.90，95CI2.61-5.83，P<0.001），但没有再狭窄（P=0.128）。在早期（II：P=0.784；III：P=0.098）和中期随访（II：P=0.216；III：P=0.227）时，威尔金斯II组和III组未显示出比I组更高的有症状MR几率。威尔金斯II组患者再狭窄的几率高于I组(OR:2.96,95CI:1.35-6.27,P=0.007)。
结论：委员会钙化（CC）是早期和中期随访PBMV后显著症状性MR（不良结局的重要决定因素）的独立预测因子。与得分≤8的I组相比，Wilkins评分较高的患者发生二尖瓣再狭窄更多。合并的Wilkins评分和CC应考虑患者对PBMV的适用性。
