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 transmitr al gradients and mitral valve morphology. Over the 39-month observatio n 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 calci fication (p = 0.05) and severity of mitral regurgitation (p = 0.0007). Patients with an echocardiographic score greater-than-or-equal-to 8 h ad a more progressive course. In addition, patients with a more progre ssive course (decline in valve area greater-than-or-equal-to 0.1 cm2/y ear) 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 p atients with an echocardiographic score < 8 and a peak mitral gradient < 10 mm Hg, only 1 patient (5%) had a more progressive course, compar ed 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 r ate of mitral valve narrowing in individual patients with rheumatic mi tral stenosis is variable. Patients whose valve disease progresses rap idly 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 he modynamics and have implications for the frequency of follow-up and pr ognosis in patients with mitral stenosis.