A prognostic score can be used to predict outcome after balloon mitral valvotomy.
Methods:
(1) NYHA (New York Heart Association) functional classification from I to IV
(2) Fluoroscopic calcification: graded 0+ (no calcification) to 4+ (dense valvular and subvalvular calcification) by fluoroscopy.
(3) Echocardiographic score for mitral valve morphology from 0 to 16 according to the score of Abascal et al (J Am Coll Cardiol. 1988; 11: 257-263).
(4) Mitral regurgitation graded 0+ to 4+ by the method of Sellers RD (Am J Cardiol. 1964; 14: 437-447).
(5) Mitral valve area measured by planimetry from the short-axis view at the tip of the mitral leaflets.
|
Variables before Procedure |
Finding |
Points |
|
age in years |
< 55 |
0 |
|
|
>= 55 |
1 |
|
NYHA functional classification |
I or II |
0 |
|
|
III or IV |
1 |
|
fluoroscopic calcification |
0 or 1+ |
0 |
|
|
2+, 3+ or 4+ |
1 |
|
echocardiographic score |
<= 8 |
0 |
|
|
> 8 |
1 |
|
cardiac rhythm |
sinus rhythm |
0 |
|
|
atrial fibrillation |
1 |
|
mitral regurgitation |
0+ |
0 |
|
|
1+ to 4+ |
1 |
|
mitral valve area by echocardiography |
>= 1 cm^2 |
0 |
|
|
< 1 cm^2 |
1 |
where:
• The original data in Table I page 773 showed mitral regurgitation was graded 1 point if 1+ or 2+; 3+ and 4+ were not mentioned. The text indicates that any degree of regurgitation increased risk.
• The original data in Table I page 773 showed 0 points if mitral valve area was < 1 and 1 point if mitral valve area was >= 1 cm^2 (reversed from above), but all of the discussion indicates that higher risk is associated with a smaller valve area.
prognostic score =
= SUM(points for the 7 variables)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score, the poorer the baseline profile.
Estimated cardiac event free survival after balloon mitral valvotomy (Table II, page 774, using Cox proportional hazard regression analysis stratified by the degree of the prognostic score)
|
Score |
1 year |
2 years |
3 years |
4 years |
5 years |
|
0 |
98 |
97 |
96 |
95 |
95 |
|
1 |
97 |
96 |
95 |
93 |
91 |
|
2 |
96 |
93 |
91 |
88 |
86 |
|
3 |
93 |
89 |
86 |
81 |
78 |
|
4 |
88 |
82 |
77 |
71 |
66 |
|
5 |
81 |
71 |
65 |
56 |
50 |
|
6 |
71 |
57 |
49 |
38 |
31 |
|
7 |
56 |
39 |
31 |
19 |
14 |
Specialty: Cardiology
ICD-10: ,
