title: Doppler echocardiographic assessment of long-term progression of mitral stenosis in 103 patients: valve area and right heart disease.
abstract: OBJECTIVE
  The purpose of this study was to determine, in a large referral population, the rate of echocardiographic change in mitral valve area (MVA) without interim intervention, to determine which factors influence progression of narrowing and to examine associated changes in the right side of the heart.
  
  
  BACKGROUND
  Little information is currently available on the echocardiographic progression of mitral stenosis, particularly on progressive changes in the right side of the heart and the ability of a previously proposed algorithm to predict progression.
  
  
  METHODS
  We studied 103 patients (mean age 61 years; 74% female) with serial two-dimensional and Doppler echocardiography. The average interval between entry and most recent follow-up study was 3.3 +/- 2 years (range 1 to 11).
  
  
  RESULTS
  During the follow-up period, MVA decreased at a mean rate of 0.09 cm2/year. In 28 patients there was no decrease, in 40 there was only relatively little change (< 0.1 cm2/year) and in 35 the rate of progression of mitral valve narrowing was more rapid (> or = 0.1 cm2/year). The rate of progression was significantly greater among patients with a larger initial MVA and milder mitral stenosis (0.12 vs. 0.06 vs. 0.03 cm2/year for mild, moderate and severe stenosis, p < 0.01). Although the rate of mitral valve narrowing was a weak function of initial MVA and echocardiographic score by multivariate analysis, no set of individual values or cutoff points of these variables or pressure gradients could predict this rate in individual patients. There was a significant increase in right ventricular diastolic area (17 to 18.7 cm2) and tricuspid regurgitation grade (2 + to 3 +; p < 0.0001 between entry and follow-up studies). Progression in right heart disease occurred even in patients with minimal or no change in MVA. Patients with associated aortic regurgitation had a higher rate of decrease in MVA than did those with trace or no aortic regurgitation (0.19 vs. 0.086 cm2/year, p < 0.05).
  
  
  CONCLUSIONS
  The rate of mitral valve narrowing in individual patients is variable and cannot be predicted by initial MVA, mitral valve score or transmitral gradient, alone or in combination. Right heart disease can progress independent of mitral valve narrowing.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sagie
authors.forename: N
authors.initials: N
authors.lastname: Freitas
authors.forename: L R
authors.initials: LR
authors.lastname: Padial
authors.forename: M
authors.initials: M
authors.lastname: Leavitt
authors.forename: E
authors.initials: E
authors.lastname: Morris
authors.forename: A E
authors.initials: AE
authors.lastname: Weyman
authors.forename: R A
authors.initials: RA
authors.lastname: Levine
mesh_terms: D000465:Algorithms; D001022:Aortic Valve Insufficiency / Q000150:complications; D016280:Atrial Function, Right / Q000502:physiology; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000150:complications; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology