A Pre-post Study on Hemodynamic Differences Following Percutaneous Mitral Commissurotomy in Mitral Stenosis Patients with Atrial Fibrillation and Sinus Rhythm

Abstract

Background: The development of atrial fibrillation (AF) is a common condition in mitral stenosis (MS), and the monitoring of hemodynamic parameters in patients after a successful percutaneous mitral commissurotomy (PMC) is of great importance for the prediction of late events. Objective: This study aimed to investigate the pre-and post-PMC hemodynamic data between AF and sinus rhythm (SR) patients.

Methods: This was a retrospective study consisting of 98 patients who underwent PMC at Suratthani Hospital between January 2013 and December 2019. Patient characteristics, echocardiogram, and hemodynamic data before and after PMC were collected, and a student t-test was applied to compare the differences between AF and SR groups.

Results: Of 98 patients, the majority of patients were in the AF category (75.5%). The age of the patients with AF was significantly higher than SR in the study (54.66±11.80 vs 48.79±13.26 years; p=0.04). Pre-PMC hemodynamic data showed that the AF group had significantly larger LA size (5.49±0.80 vs 4.95±0.63 cm; p<0.01) and higher LA pressure (25.56±8.26 vs 20.0±8.52 mmHg; p<0.01) than the SR group. After PMC, LA size was also significantly higher in the patients with AF than SR (5.16±0.73 vs 4.54±0.81 cm; p<0.01). Post-PMC LAP between the groups had a similar trend (18.76±7.17 vs 12.91±5.43 mmHg; p<0.01). However, the pre-and post-PMC readings for MVA, mean pulmonary pressure and transmitral pressure gradients were statistically not different between AF and SR groups.

Conclusion:  The patients with MS and AF were older and they had considerably larger LA size and higher LA pressure than patients with MS and SR. The SR group had lower but insignificantly different pulmonary artery systolic pressure than the AF group in the study.