Hemodynamics and clinical outcomes of combined aortic stenosis and rheumatic mitral stenosis

Omer, Mohamed H. ORCID: https://orcid.org/0000-0001-5967-9984, Marek, Josef, ALHemayed, Waleed, Al-Humaid, Mohammed, Ahmad, Omar, Janjua, Mohammed, Capoulade, Romain, Alassas, Khadija, Pibarot, Philippe, Fadel, Bahaa and Mohty, Dania 2025. Hemodynamics and clinical outcomes of combined aortic stenosis and rheumatic mitral stenosis. Presented at: American College of Cardiology's 74th Annual Scientific Session & Expo, Chicago, IL, USA, 29-31 March 2025. Journal of the American College of Cardiology. , vol.85 (2311) Elsevier, 10.1016/S0735-1097(25)02795-0

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Abstract

Background There is limited data on the clinical characteristics of patients with aortic stenosis (AS) and concomitant mitral stenosis (MS). This study aimed to assess the prevalence, clinical features, echocardiographic parameters, and survival outcomes of patients with combined AS-MS compared to those with isolated AS. Methods We retrospectively identified patients with significant AS (aortic valve area ≤1.0 cm²) and concomitant significant MS (mitral valve area ≤2.0 cm²) from the echocardiography database between January 2002 and December 2017. Exclusion criteria included left ventricular ejection fraction <50%, other significant valvular lesions, prior cardiac surgery, and congenital heart disease. Following patient exclusion, patients with isolated AS were compared to patients with combined AS and MS. Results 353 patients were included: 41 with combined AS-MS and 312 with isolated AS. The prevalence of combined AS-MS was 11% among patients with significant AS. Compared to patients with lone AS, patients with combined AS-MS were younger (50 vs 63 years, P<0.001), had a lower prevalence of hypertension (44% vs 64%, P=0.017) and diabetes (22% v. 42%, P=0.013), and a greater prevalence of atrial fibrillation (17% vs. 5%, P=0.003). Echocardiographic parameters assessing AS severity, stroke volume index, and transvalvular flow rate, did not differ significantly between the two groups. However, patients with combined AS-MS had a significantly larger left atrial size (4.79 ± 0.70 cm vs 3.93 ± 0.73 cm, P<0.001), higher peak tricuspid velocities (3.14 ± 0.59 m/s vs 2.72 ± 0.45 m/s, P<0.001), and greater prevalence of moderate or severe tricuspid regurgitation (15% vs 1%, P<0.001). After multivariate adjustment for age, gender, and comorbidities, combined AS-MS was independently associated with worse 5-year overall survival (HR 2.672, 95% CI 1.060-6.732, P=0.037). Conclusion Combined AS-MS is uncommon (11%) but linked to worse outcomes than isolated AS. Despite expectations, MS did not increase paradoxical low-flow, low-gradient AS. These findings underscore the need for further studies to validate diagnostic approaches and explore hemodynamic mechanisms in combined AS-MS.

Item Type:	Conference or Workshop Item (Poster)
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Elsevier
ISSN:	0735-1097
Last Modified:	12 Jun 2025 14:08
URI:	https://orca.cardiff.ac.uk/id/eprint/178502

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