Differential Impact of Net Atrioventricular Compliance on Clinical Outcomes in Patients with Mitral Stenosis According to Cardiac Rhythm

In Jeong Cho, Hyuk Jae Chang, Soo Yeon Lee, Chi Young Shim, Geu Ru Hong, Namsik Chung

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background Net atrioventricular compliance (Cn), a parameter for the net compliance of the left atrium and left ventricle, is known to be a useful predictor of outcomes in patients with mitral stenosis (MS). The present study aimed to evaluate whether the impact of Cn on symptom status and clinical outcomes, as well as its contribution toward systolic pulmonary artery pressure (SPAP), differed according to cardiac rhythm. Methods We retrospectively reviewed patients (N = 308) with rheumatic pure MS. Doppler-derived Cn was calculated using planimetered mitral valve area and E-wave downslope of transmitral flow. The primary endpoint was defined as a composite of all-cause death, percutaneous mitral valvotomy, surgical mitral valve replacement, admission for heart failure, and stroke. Results Overall, there were 178 patients (58%) with sinus rhythm (SR) and 130 patients (42%) with atrial fibrillation (AF). In multivariable linear regression analysis, there was a significant independent association between Cn and SPAP in patients with SR (P =.014), but not in those with AF (P =.112). During a median follow-up of 38 months, 130 patients (27%) experienced the study endpoint. In multivariable Cox regression, high Cn was associated with a more favorable prognosis in patients with SR (hazard ratio = 0.83; 95% CI, 0.69-0.99; P =.038). Conversely, high Cn was not found to offset the burden of adverse clinical outcomes in those with AF (hazard ratio = 1.18; 95% CI, 0.99-1.40; P =.071). Conclusions Cn appears to be associated with SPAP and clinical outcomes in MS patients with SR. The predictive role of Cn in patients with AF requires further clarification.

Original languageEnglish
Pages (from-to)552-560
Number of pages9
JournalJournal of the American Society of Echocardiography
Issue number6
StatePublished - Jun 2017

Bibliographical note

Funding Information:
This research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (grant no. 2012027176).

Publisher Copyright:
© 2017 American Society of Echocardiography


  • Cardiac rhythm
  • Compliance
  • Mitral valve stenosis
  • Outcome assessment


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