2-DIMENSIONAL AND DOPPLER ECHOCARDIOGRAPHIC DETERMINANTS OF THE NATURAL-HISTORY OF MITRAL-VALVE NARROWING IN PATIENTS WITH RHEUMATIC MITRAL-STENOSIS - IMPLICATIONS FOR FOLLOW-UP

Fifty patients with rheumatic mitral stenosis were studied with serial two-dimensional and Doppler echocardiography to determine the natural history of changes in mitral valve area and its relation to transmitral gradients and mitral valve morphology. Over the 39-month observation period (range 7 to 74 months) the decline in valve area was 0.09 +/- 0.21 cm2/year. In addition, there were significant increases in total echocardiographic score (p = 0.0001), severity of mitral anulus calcification (p = 0.05) and severity of mitral regurgitation (p = 0.0007). Patients with an echocardiographic score greater-than-or-equal-to 8 had a more progressive course. In addition, patients with a more progressive course (decline in valve area greater-than-or-equal-to 0.1 cm2/year) had a greater initial mean gradient (p = 0.01), peak gradient (p = 0.007) and total echocardiographic score (p = 0.0008). Initial valve area did not correlate with the rate of stenosis progression. Of 22 patients with an echocardiographic score < 8 and a peak mitral gradient < 10 mm Hg, only 1 patient (5%) had a more progressive course, compared with 80% of those with a total echocardiographic score greater-than-or-equal-to 8 and a gradient greater-than-or-equal-to 10 mm Hg. The rate of mitral valve narrowing in individual patients with rheumatic mitral stenosis is variable. Patients whose valve disease progresses rapidly are those with a greater mitral valve echocardiographic score and higher peak and mean transmitral gradients. These findings emphasize the importance of noninvasive evaluation of valvular morphology and hemodynamics and have implications for the frequency of follow-up and prognosis in patients with mitral stenosis.