Dimensionless Index of the Mitral Valve for Evaluation of Degenerative
Purpose: Degenerative mitral stenosis (DMS) is an increasingly
recognized cause of mitral stenosis. The goal of this study was to
compare echocardiographic differences between DMS and rheumatic mitral
stenosis (RMS), identify echocardiographic variables reflective of DMS
severity, and propose a dimensionless mitral stenosis index (DMSI) for
assessment of DMS severity. Methods: This is a single-center,
retrospective cohort study. We included patients with at least mild MS
and a mean transmitral pressure gradient (TMPG) ≥ 4 mmHg. Mitral valve
area by the continuity equation (MVACEQ) was used as an independent
reference. The DMSI was calculated as follows: DMSI = VTILVOT / VTIMV.
All-cause mortality data were collected retrospectively. Results: A
total of 64 patients with DMS and 24 patients with RMS were identified.
MVACEQ was larger in patients with DMS (1.43 0.4 cm2) than RMS (0.9
0.3 cm2) by ~0.5 cm2 (p = <0.001) and mean
TMPG was lower in the DMS group (6.0 2 vs. 7.93 mmHg, p=0.003). A DMSI
of 0.50 and ≤ 0.351 were associated with MVACEQ ≤ 1.5 and MVACEQ ≤ 1.0
cm2 (p<0.001), respectively. With the progression of DMS from
severe to very severe, there was a significant drop in DMSI. There was a
non-significant trend towards worse survival in patients with MVACEQ ≤
1.0 cm2 and DMSI ≤ 0.35, suggesting severe stenosis severity.
Conclusion: Our results show that TMPG correlates poorly with MVA in
patients with DMS. Proposed DMSI may serve as a simple echocardiographic
indicator of hemodynamically significant DMS.