J Korean Med Sci.  2024 May;39(17):e152. 10.3346/jkms.2024.39.e152.

Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea

• Lee HJ
• Cho I
• Kim DY
• Son JW
• Choi KU
• Lee S
• Kim IC
• Ko KY
• Ha KE
• Gwak SY
• Kim K
• Seo J
• Kim H
• Shim CY
• Ha JW
• Kim H
• Hong GR
• Narula J

• KMID: 2555496
• DOI: http://doi.org/10.3346/jkms.2024.39.e152

Abstract

Background
The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth.
Methods
From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed.
Results
Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6–73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy.
Conclusion
This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.

Keyword

Trend Change; Rheumatic Mitral Stenosis; Rheumatic Heart Disease; Korea

Figure

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  Fig. 1 Flowchart of the current study.MASTER = Multicenter mitrAl STEnosis with Rheumatic etiology, MS = mitral stenosis, MVA = mitral valve area.

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  Fig. 2 Temporal trends of (A) ages at first diagnosis, (B) ages considering a mitral intervention, (C) type of treatment strategy, and (D) use of anticoagulation rate within five years after diagnosis.Period 1: Before 2005, Period 2: 2006–2010, Period 3: 2011–2015, Period 4: After 2016 (Open commissurotomy was done in only one case in Period 1 and Period 3).SD = standard deviation, MVR = mitral valve replacement, PMV = percutaneous mitral valvuloplasty.

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  Fig. 3 Temporal trends for cumulative incidences of composite outcome (A), all-cause death (B), hospitalization for HF (C), and ischemic stroke (D) were estimated using the Kaplan–Meier method.Period 1: Before 2005, Period 2: 2006–2010, Period 3: 2011–2015, Period 4: After 2016.HF = heart failure.

• 

  Fig. 4 The survival rate of composite outcome divided by period and treatment strategy.Period 1: Before 2005, Period 2: 2006–2010, Period 3: 2011–2015, Period 4: After 2016.

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