Heart and Vascular Institute, Einstein Medical Center, Philadelphia, Pennysylvania.
Heart and Vascular Institute, Einstein Medical Center, Philadelphia, Pennysylvania.
Am J Cardiol. 2020 May 15;125(10):1536-1542. doi: 10.1016/j.amjcard.2020.02.020. Epub 2020 Mar 5.
Mitral stenosis is classically caused by rheumatic disease (RMS). However, degenerative mitral stenosis (DMS) is increasingly encountered, particularly in developed countries with aging populations. The aim of this study was to compare clinical and echocardiographic characteristics between the 2 entities. One hundred fifteen patients with DMS were identified from an echocardiographic database in the United States and compared with 510 patients with RMS from Seoul, Korea. All subjects had a mitral valve area (MVA) ≤2.5 cm by continuity equation but were otherwise unselected. Patients with DMS were older and had more hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease than those with RMS. Atrial fibrillation was more common in RMS patients. Mean mitral valve gradient was slightly lower in DMS versus RMS (7.63 ± 3.67 vs 8.50 ± 4.23 mm Hg, p = 0.04) but MVA was strikingly higher in the DMS group (1.35 ± 0.41 vs 0.95 ± 0.38 cm, p <0.0001). This appeared to be due to greater stroke volume in the DMS patients (70.4 ± 19.7 vs 55.7 ± 15.5 ml, p <0.0001). Indexed left atrial volume was greater in RMS (82.1 ± 40.3 vs 57.9 ± 21.4 ml, p <0.0001) while estimated pulmonary artery systolic pressure was greater in DMS (49.3 ± 16.5 vs 39.4 ± 13.6 mm Hg, p <0.0001). In conclusion, DMS patients are older and have more comorbidities than RMS patients. DMS presents with greater MVA relative to mean mitral valve gradient than RMS. This appears due to a higher stroke volume in DMS patients.
二尖瓣狭窄经典地由风湿性疾病（RMS）引起。然而，退行性二尖瓣狭窄（DMS）在人口老龄化的发达国家中越来越常见。本研究旨在比较这两种疾病的临床和超声心动图特征。从美国的超声心动图数据库中确定了 115 例 DMS 患者，并与韩国首尔的 510 例 RMS 患者进行了比较。所有患者的二尖瓣瓣口面积（MVA）均通过连续方程≤2.5cm，但未经选择。DMS 患者比 RMS 患者年龄更大，高血压、糖尿病、慢性肾脏病和慢性阻塞性肺疾病更多。心房颤动在 RMS 患者中更为常见。DMS 患者的平均二尖瓣瓣口压差略低于 RMS（7.63±3.67 vs 8.50±4.23mmHg，p=0.04），但 DMS 组的 MVA 明显更高（1.35±0.41 vs 0.95±0.38cm，p<0.0001）。这似乎是由于 DMS 患者的每搏量更大（70.4±19.7 vs 55.7±15.5ml，p<0.0001）。RMS 患者的左心房容积指数更大（82.1±40.3 vs 57.9±21.4ml，p<0.0001），而 DMS 患者的估测肺动脉收缩压更高（49.3±16.5 vs 39.4±13.6mmHg，p<0.0001）。总之，DMS 患者比 RMS 患者年龄更大，合并症更多。与 RMS 相比，DMS 患者的 MVA 与平均二尖瓣瓣口压差相关更大。这似乎是由于 DMS 患者的每搏量更高。
