Circulation: Cardiovascular Imaging HCI Impact of Net Atrioventricular Compliance on Clinical Outcome in Mitral Stenosis Nunes et al: Net Atrioventricular Compliance in Mitral Stenosis CIRCCVIM/2013/000328 CIRCCVIM/2013/000328 10.1161/CIRCIMAGING.112.000328 6 11/19/13 6 Picillo Emily 617-542-5100 617-542-6539 Marwick, Thomas University of Tasmania Prof. Maria Carmo Pereira Nunes(Maria Carmo Pereira Nunes) mcarmo@waymail.com.br Prof. School of Medicine, Federal University of Minas Gerais Av Professor Alfredo Balena, 190, Santa Efig�nia Belo Horizonte N/A 30130100 BRAZIL 55-31-34099746 55-31-34099437 62964 Maria Carmo Pereira Nunes(Maria Carmo Pereira Nunes) School of Medicine, Federal University of Minas Gerais mcarmo@waymail.com.br 62964 Judy Hung Massachusetts General Hospital jhung@partners.org 62671 Marcia Melo Barbosa * School of Medicine, Federal University of Minas Gerais marciambarbosa@terra.com.br 116463 William Antonio Esteves School of Medicine, Federal University of Minas Gerais waesteves@hotmail.com 116464 Vinicius Carvalho School of Medicine, Federal University of Minas Gerais v-tostes@uol.com.br 116465 Lucas Lodi-Junqueira School of Medicine, Federal University of Minas Gerais lucaslodi@yahoo.com.br 116466 Cirilo Fonseca Neto School of Medicine, Federal University of Minas Gerais ciriloneto@task.com.br 116467 Timothy C Tan Massachusetts General Hospital, Harvard Medical School tctan@partners.org 93285 Robert A Levine Massachusetts General Hospital rlevine@partners.org 42824 09/20/2012 09/20/2012 09/03/2013 09/14/2013 10/04/2013 11/19/2013 Original Articles net atrioventricular compliance CIRCCVIM/2012/981266 Impact of Net Atrioventricular Compliance on Clinical Outcome in Mitral Stenosis CIRCCVIM/2012/981266 Impact of Net Atrioventricular Compliance on Clinical Outcome in Mitral Stenosis <p><b><i>Background</i></b>—Net atrioventricular compliance (C<sub>n</sub>) has been reported to be an important determinant of pulmonary hypertension in mitral stenosis (MS). We hypothesized that, as C<sub>n</sub> reflects hemodynamic consequences of MS, it may be useful in assessing prognosis. To date, limited data with an assumed C<sub>n</sub> cutoff have indicated the need for larger prospective studies. This prospective study was designed to determine the impact of C<sub>n</sub> on clinical outcome and its contribution to pulmonary pressure in MS. In addition, we aimed to identify a cutoff value of C<sub>n</sub> for outcome prediction in this setting. </p><p><b><i>Methods and Results</i></b>—A total of 128 patients with rheumatic MS without other significant valve disease were prospectively enrolled. Comprehensive echocardiography was performed and Doppler-derived C<sub>n</sub> estimated using a previously validated equation. The endpoint was either mitral valve intervention or death. C<sub>n</sub> was an important predictor of pulmonary pressure, regardless of classic measures of MS severity. During a median follow-up of 22 months, the endpoint was reached in 45 patients (35%). Baseline C<sub>n</sub> predicted outcome, adding prognostic information beyond that provided by mitral valve area and functional status. C<sub>n</sub> ≤ 4 mL/mmHg best predicted unfavorable outcome in derivation and validation sets. A subgroup analysis including only initially asymptomatic patients with moderate to severe MS without initial indication for intervention (40.6 % of total) demonstrated that baseline C<sub>n</sub> predicted subsequent adverse outcome even after adjusting for classic measures of hemodynamic MS severity (hazard ratio [HR] 0.33, 95% confidence interval [CI] 0.14-0.79, p = 0.013). </p><p><b><i>Conclusions</i></b>—C<sub>n</sub> contributes to pulmonary hypertension beyond of stenosis severity itself. In a wide spectrum of MS severity, C<sub>n</sub> is a powerful predictor of adverse outcome, adding prognostic value to clinical data and mitral valve area. Importantly, baseline C<sub>n</sub> predicts a progressive course with subsequent need for intervention in initially asymptomatic patients. C<sub>n</sub> assessment therefore has potential value for clinical risk stratification and monitoring in MS patients.</p> 4 2 1 2 5 no yes CIRCCVIM_CIRCCVIM-2013-000328.xml CIRCCVIM_CIRCCVIM-2013-000328_supp1.doc CIRCCVIM_CIRCCVIM-2013-000328_file1.doc
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CIRCCVIM_CIRCCVIM-2013-000328_merge.pdf CIRCCVIM_CIRCCVIM-2013-000328_Lodi-Junqueira_116466_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Lodi-Junqueira_116466_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Nunes_62964_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Nunes_62964_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Fonseca_Neto_116467_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Fonseca_Neto_116467_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Hung_62671_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Hung_62671_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Tan_93285_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Tan_93285_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Levine_42824_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Levine_42824_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Esteves_116464_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Esteves_116464_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Barbosa_116463_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Barbosa_116463_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000328_Carvalho_116465_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000328_Carvalho_116465_copyright.pdf Please charge authors $70 per page MS has clinical perspective Footnote: Guest Editor for this article was Thomas H. Marwick, MBBS, PhD, MPH Please set the flag 'exportcadmusahafundingtypecodes' with the funding type code of the sources you wish to list. Subject Codes: [31] Echocardiography epicillo