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Emboli and Mitral Stenosis: A Risk Even in Sinus Rhythm?

The risk for systemic embolism in patients with mitral stenosis needs to be better defined. These investigators prospectively studied 534 adults with mitral stenosis presenting to a university hospital in Taiwan.

All patients underwent transthoracic echocardiography, and 48 percent took anticoagulants. Over an average of 37 months, 9 percent of patients in sinus rhythm and 12 percent of those in atrial fibrillation (AF) had a sudden onset of peripheral arterial ischemic or neurologic manifestations confirmed by testing or surgery. For patients in sinus rhythm, older age, the presence of a left atrial thrombus by transthoracic echocardiography, significant aortic regurgitation, and larger mitral valve (MV) areas were independently associated with systemic emboli. (However, when patients with previous balloon commissurotomy were excluded, MV area was no longer a significant predictor.) For patients in AF, balloon mitral valve commissurotomy predicted a reduced likelihood of systemic emboli; prior emboli predicted an increased likelihood.

Comment: This report provides scant information on patient selection, follow-up, statistical adjustments in the analyses, and cut-off points for significant risk factors. Nonetheless, the substantial risk of systemic emboli in the patients with sinus rhythm, if confirmed in other studies, implies that some might benefit from anticoagulation.

— R Saitz

Published in Journal Watch General Medicine June 12, 1998

Citation(s):

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

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