Can a novel echocardiographic score better predict outcome after percutaneous balloon mitral valvuloplasty?

OBJECTIVE: The assessment of patients with mitral stenosis before percutaneous balloon mitral valvuloplasty (PBMV) is crucial to predict outcome after the procedure. We tried to explore the prognostic power of a novel echocardiographic score to predict immediate postprocedural outcome in comparison to the standard score.

METHODS: We enrolled 50 consecutive patients with moderate to severe mitral stenosis admitted to undergo PBMV. For all patients, we assessed both the standard Massachusetts General Hospital (MGH) score and a novel score based on calcification (especially commissural) and subvalvular involvement. Patients underwent PBMV with the double balloon technique. Thereafter, patients were classified into two groups: group 1 (poor outcome) defined as no procedural success and/or increase of MR by more than 1 grade and group 2 (optimal outcome) defined as procedural success with increase of MR by 1 grade or less.

RESULTS: The total MGH score did not differ significantly between the two groups. However, among the individual parameters of the score, both calcification and subvalvular affection were significantly higher in group 1 versus group 2 (2.8 +/- 0.4 versus 1.7 +/- 0.8, and 2.4 +/- 0.5 versus 1.6 +/- 0.4, respectively, P < 0.01 for both). The total novel score and its two individual parameters (calcification and subvalvular involvement) were all significantly higher in group 1 versus group 2 (6 +/- 1.5 versus 2.9 +/- 1.9, 4.9 +/- 1.2 versus 2.4 +/- 1.5, 1.5 +/- 1.6 versus 0.5 +/- 0.9, respectively, P < 0.01 for all). Multivariate analysis demonstrated the novel score to be the only independent predictor of poor outcome.

CONCLUSION: The novel score is more reliable and correlates with outcome better than the standard score.