Clinical and echocardiographic differences between rheumatic and degenerative mitral stenosis.
10.47102/annals-acadmedsg.2024351
- Author:
Ryan LEOW
1
;
Ching-Hui SIA
1
;
Tony Yi-Wei LI
1
;
Meei Wah CHAN
1
;
Eng How LIM
1
;
Li Min Julia NG
2
;
Tiong-Cheng YEO
1
;
Kian-Keong POH
1
;
Huay Cheem TAN
1
;
William Kf KONG
1
Author Information
1. Department of Cardiology, National University Heart Centre, Singapore.
2. Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore.
- Publication Type:Comparative Study
- Keywords:
calcific mitral stenosis;
degenerative mitral stenosis;
mitral stenosis;
rheumatic heart disease;
valvular heart disease
- MeSH:
Humans;
Mitral Valve Stenosis/etiology*;
Male;
Female;
Retrospective Studies;
Middle Aged;
Aged;
Rheumatic Heart Disease/mortality*;
Echocardiography;
Hospitalization/statistics & numerical data*;
Heart Failure/epidemiology*;
Singapore/epidemiology*;
Proportional Hazards Models;
Diabetes Mellitus/epidemiology*
- From:Annals of the Academy of Medicine, Singapore
2025;54(4):227-234
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Degenerative mitral stenosis (DMS) is frequently cited as increasing in prevalence in the developed world, although comparatively little is known about DMS in comparison to rheumatic mitral stenosis (RMS).
METHOD:A retrospective observational study was conducted on 745 cases of native-valve mitral stenosis (MS) with median follow-up time of 7.25 years. Clinical and echocardiographic parameters were compared. Univariate and multivariate Cox regression analyses were performed for a composite of all-cause mortality and heart failure hospitalisation.
RESULTS:Patients with DMS compared to RMS were older (age, mean ± standard deviation: 69.6 ± 12.3 versus [vs] 51.6 ± 14.3 years, respectively; P<0.001) and a greater proportion had medical comorbidities such as diabetes mellitus (78 [41.9%] vs 112 [20.0%], P<0.001). The proportion of cases of degenerative aetiology increased from 1.1% in 1991-1995 to 41.0% in 2016-2017. In multivariate analysis for the composite outcome, age (hazard ratio [HR] 95% confidence interval [CI] of 1.032 [1.020-1.044]; P<0.001), diabetes mellitus (HR 1.443, 95% CI 1.068-1.948; P=0.017), chronic kidney disease (HR 2.043, 95% CI 1.470-2.841; P<0.001) and pulmonary artery systolic pressure (HR 1.019, 95% CI 1.010- 1.027; P<0.001) demonstrated significant indepen-dent associations. The aetiology of MS was not independently associated with the composite outcome.
CONCLUSION:DMS is becoming an increasingly common cause of native-valve MS. Despite numerous clinical differences between RMS and DMS, the aetiology of MS did not independently influence a composite of mortality or heart failure hospitalisation.
