Predicting Success and Long-Term Outcomes of Percutaneous Mitral Valvuloplasty: A Multifactorial Score

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• 作者：Ignacio Cruz-Gonzalez ; Maria Sanchez-Ledesma ; Pedro L. Sanchez ; Javier Martin-Moreiras ; Hani Jneid ; Pablo Rengifo-Moreno ; Ignacio Inglessis-Azuaje ; Andrew O. Maree ; Igor F. Palacios
• 关键词：Percutaneous mitral valvuloplasty ; Prognosis ; Score
• 刊名：The American Journal of Medicine
• 出版年：2009
• 出版时间：June 2009
• 年：2009
• 卷：122
• 期：6
• 页码：581.e11-581.e19
• 全文大小：914 K

文摘

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.