Predictors of systemic embolism in patients with mitral stenosis. A prospective study.
BACKGROUND
Most studies of the predictors of systemic embolism in patients with mitral stenosis have been retrospective.


OBJECTIVE
To prospectively study factors associated with systemic embolism in mitral stenosis.


METHODS
Prospective cohort study.


METHODS
University-affiliated medical institution with 3000 beds.


METHODS
534 consecutive patients with a mitral valve area of 2.0 cm2 or less; 132 patients were in sinus rhythm, and 402 were in atrial fibrillation.


METHODS
Nine clinical and 10 echocardiographic variables were assessed for prediction of systemic embolism over a mean (+/- SD) follow-up of 36.9 +/- 22.5 months. Diagnosis of systemic embolism was based on symptoms and signs (sudden onset of peripheral arterial ischemic or neurologic manifestations without prodromes) and on findings on computed tomography, angiography, and surgery.


RESULTS
For patients in sinus rhythm, age (relative risk [RR], 1.12 [95% CI, 1.04 to 1.21]), the presence of a left atrial thrombus (RR, 37.1 [CI, 2.82 to 487.8]), mitral valve area (RR, 16.9 [CI, 1.53 to 187.0]), and the presence of significant aortic regurgitation (RR, 22.4 [CI, 2.72 to 184.8]) were positively associated with embolism. For patients in atrial fibrillation, previous embolism (RR, 3.11 [CI, 1.66 to 5.85]) was positively associated with embolism; percutaneous balloon mitral commissurotomy (RR, 0.37 [CI, 0.18 to 0.79]) was a negative predictor.


CONCLUSIONS
It may be prudent to give anticoagulants not only to patients in atrial fibrillation and patients with previous systemic embolism but also to those showing a left atrial thrombus or significant aortic regurgitation on echocardiography. Early percutaneous balloon mitral commissurotomy may also help prevent systemic embolism in patients with mitral stenosis.
Chiang
C W
CW
Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan, Republic of China.
Lo
S K
SK
Ko
Y S
YS
Cheng
N J
NJ
Lin
P J
PJ
Chang
C H
CH
D000328:Adult; D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D001022:Aortic Valve Insufficiency / Q000209:etiology; D004452:Echocardiography; D004617:Embolism / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed