title: Can a novel echocardiographic score better predict outcome after percutaneous balloon mitral valvuloplasty?
abstract: OBJECTIVE
  The assessment of patients with mitral stenosis before percutaneous balloon mitral valvuloplasty (PBMV) is crucial to predict outcome after the procedure. We tried to explore the prognostic power of a novel echocardiographic score to predict immediate postprocedural outcome in comparison to the standard score.
  
  
  METHODS
  We enrolled 50 consecutive patients with moderate to severe mitral stenosis admitted to undergo PBMV. For all patients, we assessed both the standard Massachusetts General Hospital (MGH) score and a novel score based on calcification (especially commissural) and subvalvular involvement. Patients underwent PBMV with the double balloon technique. Thereafter, patients were classified into two groups: group 1 (poor outcome) defined as no procedural success and/or increase of MR by more than 1 grade and group 2 (optimal outcome) defined as procedural success with increase of MR by 1 grade or less.
  
  
  RESULTS
  The total MGH score did not differ significantly between the two groups. However, among the individual parameters of the score, both calcification and subvalvular affection were significantly higher in group 1 versus group 2 (2.8 +/- 0.4 versus 1.7 +/- 0.8, and 2.4 +/- 0.5 versus 1.6 +/- 0.4, respectively, P < 0.01 for both). The total novel score and its two individual parameters (calcification and subvalvular involvement) were all significantly higher in group 1 versus group 2 (6 +/- 1.5 versus 2.9 +/- 1.9, 4.9 +/- 1.2 versus 2.4 +/- 1.5, 1.5 +/- 1.6 versus 0.5 +/- 0.9, respectively, P < 0.01 for all). Multivariate analysis demonstrated the novel score to be the only independent predictor of poor outcome.
  
  
  CONCLUSIONS
  The novel score is more reliable and correlates with outcome better than the standard score.
authors.affiliation: Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Rifaie
authors.forename: Iman
authors.initials: I
authors.lastname: Esmat
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Rahman
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D015150:Echocardiography, Doppler / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D008946:Mitral Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome