Embolic Risk Is High in Rheumatic MS, Even in Sinus Rhythm

Background: Embolic events have been reported in 5% to 15% of patients with rheumatic mitral stenosis (MS) who have sinus rhythm (SR). Guidelines recommend anticoagulation with dense left atrial (LA) “smoke,” thrombus, or enlargement, or prior embolic event(s). However, embolic risk factors have not been well studied. Objective: To assess LA reservoir strain (LASr) in MS patients in SR. Design: Retrospective, multicenter registry study. Methods: 1191 patients from the Multicenter Mitral Stenosis with Rheumatic Etiology (MASTER) registry, with mitral valve area (MVA) 2 (by planimetry), in SR were enrolled. After excluding prior valve surgery, poor image quality, significant aortic stenosis/aortic regurgitation, and patients on anticoagulation, there were 875 patients for analysis. Primary outcome was composite embolic events including ischemic stroke, transient ischemic attack (TIA), and peripheral embolism. Results: 537 patients (61.4%) had MVA 2 , and 137 (15.7%) had MVA more...