Clinical and echocardiographic differences in three different etiologies of severe mitral stenosis

Abstract Background In our institute, the causes of mitral stenosis (MS) are generally categorized into three main etiologies—rheumatic MS (RMS), degenerative MS with annular and leaflet calcification, and post‐clip MS as a consequence of transcatheter mitral valve repair with clips for treating mitral regurgitation. However, clinical differences among the three etiologies are uncertain. Methods We retrospectively assessed 293 consecutive patients (53 with RMS, 118 with degenerative MS, and 122 with post‐clip MS) who had a three‐dimensional (3D) transesophageal echocardiography (TEE) derived mitral valve orifice area (MVA) of ≤1.5 cm 2 , and a mean transmitral pressure gradient of ≥5 mmHg on transthoracic echocardiography. Results Although there was no difference in 3D‐TEE‐derived MVA among the three groups, patients with post‐clip MS had a significantly lower mean transmitral pressure gradient compared to those with either of the other two types of MS (10.8 ([7.9–15.2] mmHg vs. 9.6 [7.3–12.5] mmHg vs. 6.9 [6.0–9.2] mmHg; p < .001). Patients with RMS had a higher prevalence of dyspnea. The independent determinants of dyspnea were pressure half time in RMS, 3D‐TEE‐derived MVA and estimated right atrial pressure in degenerative MS, and left ventricle ejection fraction in post‐clip MS. Conclusions Patients with post‐clip MS had the lowest mean transmitral pressure gradient, and patients with RMS had the highest prevalence of dyspnea, despite having a similar 3D‐TEE‐derived MVA. The determinants of dyspnea were different among the three etiologies of MS.