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Siah QZ, Pang BY, Ye TT, Ho JS, Teo YH, Teo YN, Syn NL, Tan BY, Wong RC, Yeo LL, Lee EC, Li TY, Poh KK, Kong WK, Yeo TC, Chai P, Sia CH. Incidence of Acute Cerebrovascular Events in Patients with Rheumatic or Calcific Mitral Stenosis: A Systematic Review and Meta-analysis. Hellenic J Cardiol 2022; 70:80-84. [PMID: 36041698 DOI: 10.1016/j.hjc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with mitral stenosis (MS) may be predisposed to acute cerebrovascular events (ACE) and peripheral thromboembolic events (TEE). Concomitant atrial fibrillation (AF), mitral annular calcification (MAC) and rheumatic heart disease (RHD) are independent risk factors. Our aim was to evaluate the incidence of ACEs in MS patients and the implications of AF, MAC, and RHD on thromboembolic risks. METHODS This systematic review was registered on PROSPERO (CRD42021291316). Six databases were searched from inception to 19th December 2021. The clinical outcomes were composite ACE, ischaemic stroke/transient ischaemic attack (TIA), and peripheral TEE. RESULTS We included 16 and 9 papers, respectively, in our qualitative and quantitative analyses. The MS cohort with AF had the highest incidence of composite ACE (31.55%; 95%CI 3.60-85.03; I2=99%), followed by the MAC (14.85%; 95%CI 7.21-28.11; I2=98%), overall MS (8.30%; 95%CI 3.45-18.63; I2=96%) and rheumatic MS population (4.92%; 95%CI 3.53-6.83; I2=38%). Stroke/TIA were reported in 29.62% of the concomitant AF subgroup (95%CI 2.91-85.51; I2=99%) and in 7.11% of the overall MS patients (95%CI 1.91-23.16; I2=97%). However, the heterogeneity of the pooled incidence of clinical outcomes in all groups, except the rheumatic MS group, were substantial and significant. The logit-transformed proportion of composite ACE increased by 0.0141 (95% CI 0.0111-0.0171; p<0.01) per year of follow-up. CONCLUSION In the MS population, MAC and concomitant AF are risk factors for the development of ACE. The scarcity of data in our systematic review reflects the need for further studies to explore thromboembolic risks in all MS subtypes.
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Affiliation(s)
- Qi Zhuang Siah
- School of Medicine, Cardiff University, Wales, United Kingdom.
| | - Bao Yu Pang
- Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Wales, United Kingdom.
| | - Tiffany Ts Ye
- School of Medicine, Cardiff University, Wales, United Kingdom.
| | - Jamie Sy Ho
- Academic Foundation Year Programme, North Middlesex Hospital University Trust, London, United Kingdom.
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Nicholas Lx Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
| | - Raymond Cc Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
| | - Edward Cy Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - Tony Yw Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - Kian-Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - William Kf Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
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Assudani J, Singh B, Samar A, Pannu J, Singh A, Nabavizadeh F, Singh P, Sunkavalli KK, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiographic Findings in Caseous Mitral Annular Calcification. Echocardiography 2010; 27:1147-50. [DOI: 10.1111/j.1540-8175.2010.01315.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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