Abstract 11514: Adverse Events in Patients With Rheumatic Mitral Valve Disease in Sinus Rhythm
Introduction: Patients with rheumatic mitral stenosis (RMS) and atrial fibrillation (AF) have revealed a high incidence of systemic embolism. Current guidelines do not recommend anticoagulation in patient with RMS and sinus rhythm.
Hypothesis: The predictors of clinical events may facilitate adverse outcome in RMS patients with sinus rhythm.
Methods: A total 1,019 patients who diagnosed with RMS were evaluated retrospectively between March 2003 and June 2013. Of these, patients with past or present AF (n = 447), who used anticoagulants or had prior thromboembolism (n = 154), or who performed mitral valve replacement within 9-month after diagnosis (n = 125) were excluded. A total of 293 patients were included. The clinical events were defined as all cause death and systemic embolism.
Results: During the mean follow-up period of 68.2 ± 36.6 months, clinical events were developed in twenty-one patients (7.2%; embolism 12, all cause death 9) with 2.1% of average annual event rate. In the Cox-proportional hazard regression analysis, age was independent predictor of clinical events (HR 1.07 (95% CI 1.01-1.13), p = 0.026) after adjustment of confounding factors. LA dimension ≥ 47 mm showed borderline significance to predict events (HR 2.45 (95% CI 0.98 - 6.15), p = 0.057). Mitral valve area was not associated with events. In middle and old aged group (age ≥ 50), LA dimension ≥ 47 mm was a good prognosticator (HR 2.97 (95% CI 1.05 - 8.36), p = 0.040). During follow-up, sixty patients (20.5%) were developed AF with 3.5% annual event rate. LA dimension ≥ 47 mm was an independent predictor of composite all events including clinical events and development of AF.
Conclusions: New onset AF was frequently developed in patients with RMS and sinus rhythm. Because of high risk of embolism of valvular AF, we need careful follow up in these patients group. In middle and old age group, enlarged LA dimension was closely related with all cause death or systemic embolism.
Author Disclosures: H. Kim: None. G. Cho: None. Y. Kim: None. H. Kim: None. S. Lee: None. H. Kim: None. J. Park: None. Y. Yoon: None. J. Zo: None. D. Sohn: None.
- © 2014 by American Heart Association, Inc.