SPC365

Prognostic impact of mitral balloon valvuloplasty for mitral stenosis patients: when the right heart catheterization is the answer

Session: SESSÃO DE COMUNICAÇÕES ORAIS 19 - DOENÇA VALVULAR
Speaker: Fernando Nascimento Ferreira

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Fernando Nascimento Ferreira; Mariana Caetano Coelho; Bárbara Lacerda Teixeira; Sofia Jacinto; Inês Rodrigues; Ana Teresa Timóteo; Luís Bernardes; Duarte Cacela; Cristina Fondinho; Luís Almeida Morais; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mitral balloon valvuloplasty (MBV) is a well-established procedure used to treat patients with mitral stenosis, a condition that often leads to the development of pulmonary hypertension (PH). While MBV effectively reduces left atrial pressure and improves PH, previous PH is associated with worse outcomes and its prognostic value in this population is not fully understood. This study aims to assess the relevance of right heart haemodynamics, comparing to non-invasive parameters, in predicting prognosis following BMV, with a focus on determining a cut-off value for mean PAP that best correlates with patient outcomes.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objectives: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Assess the prognostic significance of mean PAP in patients undergoing balloon mitral valvuloplasty. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A retrospective analysis was performed on consecutive patients with severe mitral stenosis who underwent PMBV between 2010 and 2024 in a single centre. Mean PAP was measured for each patient, and a ROC curve analysis was used to determine the optimal cut-off value. Patients were divided into two groups based on a mean PAP threshold of 35 mmHg (derived from ROC analysis). Prognostic significance was assessed considering other factors such as age, NYHA class, Wilkins score, left atrial volume and systolic pulmonary artery pressure (SPAP).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">51 pt were included in the analysis,</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> t</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">he median age was 49 years and 80,4% were female and 50% was NYHA class III or higher, on Echo the median Wilkins score was 8, with mitral average mean gradient of 12mmHg and mean anatomic Mitral Valve area was 1,04cm2, PSAP 49,6mmHg and on right heart catheterization the average mean PAP was 35,2mmHg. ROC analysis identified a mean PAP threshold of 35 mmHg as the best predictor of adverse outcomes. Patients with PAP &gt;35 mmHg had significantly worse prognosis, with more cardiovascular death or reintervention rate, with an odds ratio of 6.65 (95% CI: 1.16&ndash;38.19). In multivariate analysis, this parameter becomes the most powerful predictor of events, comparing to non-invasive echocardiographic measures like the Wilkins score, and PSAP. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In patients undergoing balloon mitral valvuloplasty, a mean pulmonary artery pressure greater than 35 mmHg is the stronger predictor of adverse outcomes. This finding highlights the value of invasive PAP evaluation as an independent prognostic tool, comparing to non-invasive echocardiographic measures. Further research is needed to explore the benefits of incorporating PAP measurement into routine risk assessment for BMV candidates.&nbsp; </span></span></span></span></span></p>