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Predicting Systemic Embolism in Mitral Stenosis.

Prior retrospective studies have shown that mitral stenosis predisposes patients to systemic embolism, and particularly to cerebral embolism. In this prospective study, Taiwan investigators sought to carefully identify risk factors for systemic embolism.

Among 534 patients followed for just over three years, 60 had an embolic event. Independent risk factors for embolic events among the 132 patients in sinus rhythm were older age, mitral valve area, left atrial thrombus, and significant aortic regurgitation. Among the 402 patients in atrial fibrillation (AF), the only two independent predictors of embolic events were not having had a percutaneous balloon mitral commissurotomy and a history of previous systemic embolism.

Comment: This intriguing study suggests that anticoagulation should be used not only for mitral stenosis patients in AF but also for those in sinus rhythm who have left atrial thrombi or significant aortic regurgitation. The authors suggest that the latter may predispose to left atrial thrombosis by increasing left ventricular diastolic pressures, thereby reducing transmitral pressure gradients and leading to more severe left atrial stasis.

— MS Lauer

Published in Journal Watch Cardiology June 19, 1998

Citation(s):

Chiang C-W et al. Predictors of systemic embolism in patients with mitral stenosis: A prospective study. Ann Intern Med 1998 Jun 1 128 885-889.

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