Degenerative Mitral Stenosis by echocardiography: presentation and outcome

Abstract Backgroud Degenerative-mitral-stenosis (DMS) is due to degenerative mitral-annular (MAC) and valvular calcification. However, DMS impacts on outcome, and therefore potential treatment needs are poorly-known. We aimed at evaluating survival after DMS diagnosis by Doppler-Echocardiography in routine-practice. Methods and results A cohort of 2937 (75 ± 12 years,67% women) consecutive-patients diagnosed between 2003-2014 with DMS (diastolic mean gradient ≥5 mmHg), with analysis of short and long-term survival. All-patients had overt mitral annular/valvular degenerative-calcification without rheumatic-involvement. Mean-gradient was 6.5 ± 2.4 mmHg, and DMS considered mild in 50%, moderate in 44%, severe in 6%. DMS was associated with left-atrial (LA) enlargement (52 ± 23 mL/m2) and elevated pulmonary-pressure (49 ± 16 mmHg) despite generally normal ejection-fraction (61 ± 13%). DMS was associated with frequent comorbid-conditions (74%hypertension; 58%coronary disease; 52%heart-failure) and humoral alterations (haemoglobin 11.3 ± 1.8 g/dL, creatinine 1.5 ± 1.4 mg/dL). One-year mortality was 22%, most strongly related to older-age, higher-comorbidity, and abnormal haemoglobin/creatinine but only weakly to DMS severity (with anaemia 42% irrespective of DMS severity-p = 0.99; without anaemia 18%, 23% and 28% with mild, moderate and severe DMS, p < 0.0004). Long-term mortality was high (56% at 5-year) also mostly linked to aging and weakly to DMS severity (with-anaemia p = 0.90; without-anaemia: adjusted-hazard-ratio:1.30[1.19-1.42], p < 0.0001 for moderate vs. mild DMS and 1.63[1.34-1.98], p < 0.0001 for severe vs. mild DMS. Conclusions DMS is a condition of the elderly potentially resulting in severe mitral-obstruction and hemodynamic-alterations. However, DMS is frequently associated with severe comorbidities imparting considerable mortality following diagnosis, whereas DMS severity is a weak (albeit independent) determinant of mortality. Hence, patients with DMS should be carefully evaluated and interventional/surgical treatment prudently considered in those with limited comorbidity burden, particularly without-anaemia.