Diagnosis and Management of Mitral Valve Disease in the Elderly

Abstract

Calcific mitral stenosis, commonly seen in the elderly in developed countries, occurs primarily due to mitral annular calcification, and its prevalence is increasing secondary to an aging population. Mitral regurgitation, commonly seen across all age groups, occurs primarily due to anatomical or functional impairment of one or more components of the mitral apparatus or the left ventricle that are necessary for normal valve function, and its prevalence is increasing secondary to an increasing number of patients with heart failure. The current review discusses the diagnosis of and treatment options (medical, surgical, and transcatheter) for mitral valve disease, including the associated challenges, specifically in the elderly.

Keywords

calcific mitral stenosis - echocardiography - mitral annular calcification - mitral valve - primary mitral regurgitation - secondary mitral regurgitation - valvular heart disease

Publikationsverlauf

Artikel online veröffentlicht:
04. November 2024

• References

• 1 Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet 2009; 374 (9697): 1271-1283
• 2 Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368 (9540): 1005-1011
• 3 Churchill TW, Yucel E, Deferm S, Levine RA, Hung J, Bertrand PB. Mitral valve dysfunction in patients with annular calcification: JACC review topic of the week. J Am Coll Cardiol 2022; 80 (07) 739-751
• 4 Pressman GS, Agarwal A, Braitman LE, Muddassir SM. Mitral annular calcium causing mitral stenosis. Am J Cardiol 2010; 105 (03) 389-391
• 5 Fox CS, Vasan RS, Parise H. et al; Framingham Heart Study. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation 2003; 107 (11) 1492-1496
• 6 Kanjanauthai S, Nasir K, Katz R. et al. Relationships of mitral annular calcification to cardiovascular risk factors: the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis 2010; 213 (02) 558-562
• 7 Pressman GS, Movva R, Topilsky Y. et al. Mitral annular dynamics in mitral annular calcification: a three-dimensional imaging study. J Am Soc Echocardiogr 2015; 28 (07) 786-794
• 8 Baumgartner H, Hung J, Bermejo J. et al; EAE/ASE. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 2009; 10 (01) 1-25
• 9 Kato N, Pislaru SV, Padang R. et al. A novel assessment using projected transmitral gradient improves diagnostic yield of Doppler hemodynamics in rheumatic and calcific mitral stenosis. JACC Cardiovasc Imaging 2021; 14 (03) 559-570
• 10 Vahanian A, Beyersdorf F, Praz F. et al; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2022; 43 (07) 561-632
• 11 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143 (05) e35-e71
• 12 Nichol PM, Gilbert BW, Kisslo JA. Two-dimensional echocardiographic assessment of mitral stenosis. Circulation 1977; 55 (01) 120-128
• 13 Chu JW, Levine RA, Chua S. et al. Assessing mitral valve area and orifice geometry in calcific mitral stenosis: a new solution by real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2008; 21 (09) 1006-1009
• 14 Hatle L, Brubakk A, Tromsdal A, Angelsen B. Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J 1978; 40 (02) 131-140
• 15 Abascal VM, Moreno PR, Rodriguez L. et al. Comparison of the usefulness of Doppler pressure half-time in mitral stenosis in patients < 65 and > or = 65 years of age. Am J Cardiol 1996; 78 (12) 1390-1393
• 16 Jain S, Mankad SV. Echocardiographic assessment of mitral stenosis: echocardiographic features of rheumatic mitral stenosis. Cardiol Clin 2013; 31 (02) 177-191
• 17 Feindel CM, Tufail Z, David TE, Ivanov J, Armstrong S. Mitral valve surgery in patients with extensive calcification of the mitral annulus. J Thorac Cardiovasc Surg 2003; 126 (03) 777-782
• 18 Okada Y. Surgical management of mitral annular calcification. Gen Thorac Cardiovasc Surg 2013; 61 (11) 619-625
• 19 Guerrero M, Dvir D, Himbert D. et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: results from the first multicenter global registry. JACC Cardiovasc Interv 2016; 9 (13) 1361-1371
• 20 Pasca I, Dang P, Tyagi G, Pai RG. Survival in patients with degenerative mitral stenosis: results from a large retrospective cohort study. J Am Soc Echocardiogr 2016; 29 (05) 461-469
• 21 Kuyama N, Hamatani Y, Okada A. et al. Comparison of clinical characteristics, natural history and predictors of disease progression in patients with degenerative mitral stenosis versus rheumatic mitral stenosis. Am J Cardiol 2021; 143: 118-124
• 22 Singh JP, Evans JC, Levy D. et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999; 83 (06) 897-902
• 23 El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging 2018; 11 (04) 628-643
• 24 Tanimoto M, Pai RG. Effect of isolated left atrial enlargement on mitral annular size and valve competence. Am J Cardiol 1996; 77 (09) 769-774
• 25 Dujardin KS, Enriquez-Sarano M, Bailey KR, Nishimura RA, Seward JB, Tajik AJ. Grading of mitral regurgitation by quantitative Doppler echocardiography: calibration by left ventricular angiography in routine clinical practice. Circulation 1997; 96 (10) 3409-3415
• 26 Ge Y, Gupta S, Fentanes E. et al. Role of cardiac CT in pre-procedure planning for transcatheter mitral valve replacement. JACC Cardiovasc Imaging 2021; 14 (08) 1571-1580
• 27 Varadarajan P, Sharma S, Heywood JT, Pai RG. High prevalence of clinically silent severe mitral regurgitation in patients with heart failure: role for echocardiography. J Am Soc Echocardiogr 2006; 19 (12) 1458-1461
• 28 Topilsky Y, Grigioni F, Enriquez-Sarano M. Quantitation of mitral regurgitation. Semin Thorac Cardiovasc Surg 2011; 23 (02) 106-114
• 29 Grayburn PA, Roberts BJ, Aston S. et al. Mechanism and severity of mitral regurgitation by transesophageal echocardiography in patients referred for percutaneous valve repair. Am J Cardiol 2011; 108 (06) 882-887
• 30 Chelle Morales D, Uretsky S, Koulogiannis K. et al. Flail mitral leaflet or presence of the Coanda effect are not invariably associated with severe mitral regurgitation as assessed by MRI. J Am Coll Cardiol 2016; 67 (13 suppl): 1836
• 31 Grayburn PA. The importance of regurgitant orifice shape in mitral regurgitation. JACC Cardiovasc Imaging 2011; 4 (10) 1097-1099
• 32 Lancellotti P, Tribouilloy C, Hagendorff A. et al; Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013; 14 (07) 611-644
• 33 Rosenhek R. How to manage mitral valve regurgitation. Accessed August 28, 2024 at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/How-to-manage-mitral-valve-regurgitation
• 34 Zoghbi WA, Adams D, Bonow RO. et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30 (04) 303-371
• 35 Borer JS, Sharma A. Drug therapy for heart valve diseases. Circulation 2015; 132 (11) 1038-1045
• 36 Varadarajan P, Joshi N, Appel D, Duvvuri L, Pai RG. Effect of beta-blocker therapy on survival in patients with severe mitral regurgitation and normal left ventricular ejection fraction. Am J Cardiol 2008; 102 (05) 611-615
• 37 Tribouilloy C, Grigioni F, Avierinos JF. et al; MIDA Investigators. Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study. J Am Coll Cardiol 2009; 54 (21) 1961-1968
• 38 Trichon BH, O'Connor CM. Secondary mitral and tricuspid regurgitation accompanying left ventricular systolic dysfunction: is it important, and how is it treated?. Am Heart J 2002; 144 (03) 373-376
• 39 Nishino S, Watanabe N, Kimura T. et al. The course of ischemic mitral regurgitation in acute myocardial infarction after primary percutaneous coronary intervention: from emergency room to long-term follow-up. Circ Cardiovasc Imaging 2016; 9 (08) e004841
• 40 Campwala SZ, Bansal RC, Wang N, Razzouk A, Pai RG. Mitral regurgitation progression following isolated coronary artery bypass surgery: frequency, risk factors, and potential prevention strategies. Eur J Cardiothorac Surg 2006; 29 (03) 348-353
• 41 Aklog L, Filsoufi F, Flores KQ. et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation?. Circulation 2001; 104 (12, suppl 1): I68-I75
• 42 Acker MA, Parides MK, Perrault LP. et al; CTSN. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med 2014; 370 (01) 23-32
• 43 Eleid MF, Cabalka AK, Williams MR. et al. Percutaneous transvenous transseptal transcatheter valve implantation in failed bioprosthetic mitral valves, ring annuloplasty, and severe mitral annular calcification. JACC Cardiovasc Interv 2016; 9 (11) 1161-1174
• 44 Eleid MF, Whisenant BK, Cabalka AK. et al. Early outcomes of percutaneous transvenous transseptal transcatheter valve implantation in failed bioprosthetic mitral valves, ring annuloplasty, and severe mitral annular calcification. JACC Cardiovasc Interv 2017; 10 (19) 1932-1942