Idit Yedidya, Steele C. Butcher, Jan Stassen, Pieter van der Bijl, Jinghao Nicholas Ngiam, Nicholas W. S. Chew, Ching-Hui Sia, Ryan Leow, Tony Yi-Wei Li, William K. F. Kong, Kian Keong Poh, Ran Kornowski, Nina Ajmone Marsan, Victoria Delgado, Jeroen J. Bax, delgado, victoria/0000-0002-9841-2737, Yedidya, Idit, Butcher, Steele C., STASSEN, Jan, van der Bijl, Pieter, Ngiam, Jinghao Nicholas, Chew, Nicholas W. S., Sia, Ching-Hui, Leow, Ryan, Li, Tony Yi-Wei, Kong, William K. F., Poh, Kian Keong, Kornowski, Ran, Marsan, Nina Ajmone, Delgado, Victoria, and Bax, Jeroen J.
Purpose Degenerative mitral stenosis (DMS) is associated with a poor prognosis. Although mean transmitral gradient (TMG) has shown a good correlation with outcome, little is known about the association between other echocardiographic parameters and prognosis in patients with DMS. The current study aimed to evaluate the prognostic value of left atrial volume index (LAVI) in patients with DMS. Methods A total of 155 patients with DMS (72[63-80] years, 67% female) were included. The population was divided according to LAVI: normal-sized LAVI (LAVI 34 ml/m2). Results Patients with enlarged LAVI had a higher left ventricular mass index (120[96-146] vs. 91[70-112] g/m2 p < 0.001), as well as a higher prevalence of significant mitral regurgitation and severe aortic stenosis (23% vs. 10% p = 0.046 and 38% vs. 15% p=0.001, respectively) compared to patients with normal-sized LAVI. During a median follow-up of 25 months, 56 (36%) patients died. Patients with enlarged LAVI had worse prognosis compared to patients with normal-sized LAVI (p = 0.026). In multivariable Cox regression model, an enlarged LAVI was independently associated with all-cause mortality (HR 2.009, 95% CI 1.040 to 3.880, P = 0.038). Conclusion An enlarged LAVI (> 34 ml/m2) is significantly associated with excess mortality in patients with DMS. After adjusting for potential confounders, an enlarged LAVI was the only parameter that remained independently associated with prognosis. The Department of Cardiology of the Leiden University Medical Center received research grants from Medtronic, Biotronik, Boston Scientifc, GE Healthcare, and Edwards Lifesciences. Steele C Butcher received funding from European Society of Cardiology [Grant Number 000080404]. Idit Yedidya received a fellowship grant from Rabin Medical Center, Israel. Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme.