Analysis of factors associated with sinus rhythm among patients with hemodynamically significant mitral stenosis
Karolina Wojtczak-Soska, Inga Piętka, Małgorzata Lelonek
Med Sci Tech 2010; 51(3-4): RA193-197
Background: The most common arrhythmia in patients with mitral stenosis (MS) is atrial fibrillation, which is not strictly related to progression of the disease, but greatly increases the risk of thromboembolisms. The aim of this study was to find factors related to sinus rhythm among patients with hemodynamic significant MS (mitral valve area, MVA ≤2.5 cm2).
Material/Methods: Retrospective analysis was performed in 112 patients (mean age 61 years). Patients were divided into 2 groups depending on heart rhythm in standard 12-lead ECG/Holter ECG monitoring: SR group (sinus rhythm) n=37 (23% male) vs. non-SR group (paroxysmal or persistent atrial arrhythmias) n=75 (24% male). The following data were analyzed: age, sex, BMI, NYHA class, Euroscore, basic laboratory results as creatinine, lipids level, platelets and fibrinogen, markers of inflammatory process including white blood cell count and C-reactive protein, results of electrocardiography (mitral P, IRBBB/RBBB, right axis), echocardiography (MVA, EF, diastolic dimension of right ventricle ([RVD], LA/RA index, PASP) and coronary arteriography, as well as presence of hypertension, diabetes, renal failure and cigarette smoking.
Results: In order to define the factors related to the presence of SR, uni- and multivariate regression analyses were performed. Multivariate analysis showed that only RVD was significantly associated with SR (OR 0.03; 95%CI 0.002–0.46; P=0.01).
Conclusions: In patients with hemodynamically significant mitral stenosis, RVD appears to be clinically useful in prediction of sinus rhythm. A higher value of the diastolic dimension of the right ventricle correlated with a lower probability of sinus rhythm.
Keywords: mitral stenosis, heart rhythm, diastolic dimension of right ventricle