title: Progression of degenerative mitral stenosis: insights from a cohort of 254 patients.
abstract: OBJECTIVE
  Degenerative mitral stenosis (DMS) is an increasingly common echocardiographic finding, yet the clinical and biological behavior and rate of progression of the condition are unknown.
  
  
  METHODS
  A total of 254 patients was identified from the authors' echocardiographic database with DMS, defined as severe mitral annular calcification with extension into the mitral leaflets resulting in transmitral flow acceleration with a mean diastolic gradient of >2 mmHg in the absence of commissural fusion. Each patient required paired echocardiograms to have been recorded at least three months apart. Clinical, biochemical and pharmacological data were collected from each patient and related to the annualized rate of increase in mean diastolic mitral gradient and stenosis severity on a scale of 0 to 3.
  
  
  RESULTS
  The characteristics of the patients were as follows: mean age 71 +/- 15 years; female gender 73%; and left ventricular ejection fraction 66 +/- 13%. Diabetes was present in 50% of patients, renal insufficiency in 40%, and coronary artery disease in 50%. Over a follow up period of 2.6 +/- 2.2 years, the mean gradient was increased by 0.8 +/- 2.4 mmHg (range: 0-15 mmHg) per year, while the stenosis grade was increased by 0.18 +/- 0.5 (range: 0-3) per year. The rate of progression was faster in patients with lesser degrees of stenosis (p = 0.01) and low serum albumen levels (p = 0.04), and slower in those receiving beta-blockers (p = 0.01). Milder stenosis, diabetes mellitus and lack of beta-blocker use were independent predictors of faster DMS progression.
  
  
  CONCLUSIONS
  DMS progression is highly variable, but generally slow; its progression is accelerated in the presence of diabetes mellitus, but is retarded by beta-blocker use. DMS may be an active biological process offering potentially modifiable targets for intervention.
authors: Gaurav
authors: G
authors: Tyagi
authors: Patricia
authors: P
authors: Dang
authors: Ioana
authors: I
authors: Pasca
authors: Reena
authors: R
authors: Patel
authors: Ramdas G
authors: RG
authors: Pai
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications*; D002140:California / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D015987:Effect Modifier, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D016277:Ventricular Function, Left
chemical_list: D000319:Adrenergic beta-Antagonists