Original Article

Correlation of Invasive Left Atrial Pressure and Mitral Valve Area in Rheumatic Mitral Stenosis: A Cross-Sectional Study

Abstract

Background: Mitral stenosis (MS) is typically assessed using both echocardiographic and invasive methods, which are critical for treatment planning. The present study analyzed the correlation between invasively measured left atrial pressure (LAP) and mitral valve area (MVA) assessed by three-dimensional transesophageal echocardiography (3D-TEE) in patients with rheumatic MS undergoing percutaneous transluminal mitral commissurotomy (PTMC).
Methods: We conducted a cross-sectional study of 135 patients with severe rheumatic MS who were candidates for PTMC at Shahid Madani Heart Hospital, Tabriz, Iran, between April 2023 and April 2024. All patients underwent two-dimensional transthoracic echocardiography (2D-TTE) and 3D-TEE for MVA measurement. Invasive LAP and pulmonary pressures were recorded pre-procedure. Comparisons were made between patients with MVA<1 cm² and those with MVA≥1 cm².
Results: The mean MVA measured by 3D-TEE was 1.03±0.07 cm². LAP was significantly higher in patients with MVA<1 cm² than in those with MVA≥1 cm² (P=0.040). Pulmonary artery pressures also differed significantly between the groups (P=0.016 and P=0.012). Among the 135 participants, 109 patients (63.3% with MVA<1 cm² and 93.6% with LAP>15 mm Hg) reported dyspnea, while 20 patients (65% with MVA<1 cm² and 100% with LAP>15 mm Hg) reported fatigue.
Conclusions: In this study, we observed a significant correlation between invasive LAP and MVA measured by 3D-TEE. These findings suggest that invasive LAP measurement offers additional value in assessing the hemodynamic burden of severe MS.

1. Peek SF, Buczinski S. Cardiovascular diseases. In: Rebhu'n's Diseases of Dairy Cattle. 2nd ed. St. Louis, Mo.: Elsevier; 2018. p. 46.
2. Nishimura RA, Vahanian A, Eleid MF, Mack MJ. Mitral valve disease—current management and future challenges. Lancet. 2016;387(10025):1324-34.
3. Shah SN, Sharma S. Mitral stenosis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430742/
4. Meschini V, Viola F, Verzicco R. Modeling mitral valve stenosis: A parametric study on the stenosis severity level. J Biomech. 2019;84:218-26.
5. Ko YG, Ha JW, Chung N, Shim WH, Kang SM, Rim SJ, et al. Effects of left atrial compliance on left atrial
pressure in pure mitral stenosis. Catheter Cardiovasc Interv. 2001;52(3):328-33.
6. Kern MJ, Sorajja P, Lim MJ. Cardiac Catheterization Handbook. 6th ed. Philadelphia, PA: Elsevier Health Sciences; 2015.
7. Pérez de Isla L, Casanova C, Almería C, Rodrigo JL, Cordeiro P, Mataix L, et al. Which method should be
the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo. Eur J Echocardiogr. 2007;8(6):470-3.
8. Nichol PM, Gilbert BW, Kisslo JA. Two-dimensional echocardiographic assessment of mitral stenosis. Circulation. 1977;55(1):120-8.
9. Grewal J, Mankad S, Freeman WK, Click RL, Suri RM, Abel MD, et al. Real-time three-dimensional
transesophageal echocardiography in the intraoperative assessment of mitral valve disease. J Am Soc Echocardiogr. 2009;22(1):34-41.
10. Ladányi Z, Eltayeb A, Fábián A, Ujvári A, Tolvaj M, Tokodi M, et al. The effects of mitral stenosis on right ventricular mechanics assessed by three- dimensional echocardiography. Sci Rep.
2024;14(1):17112.
11. Bleakley C, Eskandari M, Aldalati O, Moschonas K, Huang M, Whittaker A, et al. Impact of 3D echocardiography on grading of mitral stenosis and prediction of clinical events. Echo Res Pract. 2018;5(4):105-11.
12. Omar AK, Sharma V, Kumar V, Mustaqueem A, Shrivastava S. Three-Dimensional Echo and Three- Dimensional Transesophageal Echocardiography for Mitral Valve Disease. J Indian Acad Echocardiogr Cardiovasc Imaging. 2019;3(3):163-76.
13. Toufan M, Aghdam NK. The Most Accurate Method for Measurement of Mitral Valve Area in Mitral
Stenosis by Direct Planimetery Three Dimensional Transesophageal Echocardiography (3D TEE). Adv Biosci Clin Med. 2018;6(4):33-7.
14. Salustri A, Almaghrabi A. Mitral valve disease correlation between the most important echocardiographic parameters and haemodynamics. E-J Cardiol Pract. 2018 [cited 2024];16(24). Available from: https://www.escardio.org/Journals/E-Journal- of-Cardiology-Practice/Volume-16/mitral-valve- disease-correlation-between-the-most-important- echocardiographic-parameters-and- aemodynamics
15. Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374(9697):1271-83.
16. El Sabbagh A, Reddy YN, Barros‐Gomes S, Borlaug BA, Miranda WR, Pislaru SV, et al. Low‐gradient severe mitral stenosis: hemodynamic profiles, clinical characteristics, and outcomes. J Am Heart Assoc. 2019;8(5):e010736.
17. Tomšič A, Hiemstra YL, Arabkhani B, Mertens BJA, van Brakel TJ, Versteegh MIM, et al. Risk factors and clinical significance of elevated mitral valve gradient following valve repair for degenerative disease. Eur J Cardiothorac Surg. 2020;57(2):293-9.
18. Halaby R, Herrmann HC, Gertz ZM, Lim S, Kar S, Lindenfeld J, et al. Effect of mitral valve gradient after MitraClip on outcomes in secondary mitral regurgitation: results from the COAPT trial. JACC Cardiovasc Interv. 2021;14(8):879-89.
19. Ko KY, Cho I, Kim S, Seong Y, Kim DY, Seo JW, et al. Identification of Distinct Subgroups in Moderately Severe Rheumatic Mitral Stenosis Using Data-Driven Phenotyping of Longitudinal Hemodynamic Progression. J Am Heart Assoc. 2022;11(15):e026375.
20. Cherry AD, Maxwell CD, Nicoara A. Intraoperative Evaluation of Mitral Stenosis by Transesophageal Echocardiography. Anesth Analg. 2016;123(1):14- 20.
21. Matshela MR. Prognostic value of the most important parameters during echocardiographic valuation of mitral valve disease. E-J Cardiol Pract. 2018 [cited 2024];16(23). Available from: https://www.escardio.org/Journals/E-Journal-of- Cardiology-Practice/Volume-16/prognostic-value-of- the-most-important-parameters-during-echocardiographic-evaluation-of-mitral-valve- disease
22. Wunderlich NC, Dalvi B, Ho SY, Kuex H, Siegel RJ. Rheumatic mitral valve stenosis: diagnosis and treatment options. Curr Cardiol Rep. 2019;21(3):14.
23. Figueiredo FdA, Esteves WAM, Hung J, Gomes NFA, Taconeli CA, Pantaleão AN, et al. Left atrial function in patients with rheumatic mitral stenosis: addressing prognostic insights beyond atrial fibrillation prediction. Eur Heart J Imaging Methods Pract. 2024;2(2):qyae067.
24. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA
guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77(4):e25-e197.
Files
IssueVol 20 No 2 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v20i2.19705
Keywords
Mitral Valve Stenosis Left Atrial Pressure Mitral Valve Area Echocardiography

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Yaghubi R, Khezerlou N, Nemati S, Faraji H, Javanshir E, Shamsian Z. Correlation of Invasive Left Atrial Pressure and Mitral Valve Area in Rheumatic Mitral Stenosis: A Cross-Sectional Study. Res Heart Yield Transl Med. 2025;20(2):97-104.