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Valvular heart diseases, particularly mitral stenosis, can potentially disturb quality of life. In this study, we aimed to search whether presence of atrial fibrillation (AF) influence the quality of life in patients with mitral stenosis.
Eighty seven consecutive patients with mild to moderate rheumatic MS, who were admitted to outpatient department, were enrolled into the study. All patients underwent quality of life scoring via SF-36 after complete transthoracic echocardiographic evaluation. Patients were classified into two as those with mitral valve area (MVA) ≤1.5 cm2 (hemodynamically significant) and those with valve area >1.5 cm2.
Mean age was 49.3±14.6 years (72 females, 15 males). Mean planimetric valve are was 1.55±0.27 cm2, mean peak transmitral gradient was 14±5.5 mmHg with a mean EF of 56±8%. 51 patients were in sinus rhythm whereas 36 patients had atrial fibrillation during evaluation (persistent or permanent). Of note, as per protocol, all patients were well treated in terms of rate control before echocardiographic evaluation, and no patient was exceeding 100 beats/min. MVA was not related with AF such that 60.5% (26/43) of those with MVA ≤1.5 cm2 had AF versus 56.8% (25/44) of those with MVA >1.5 cm2 had AF (p=0.898).
In the group with MVA ≤1.5 cm2, presence or absence of AF did not influence total score of SF-36 (92±18 vs. 90±19, p=0.437) including all subscales of SF-36. Those with AF were older than those without AF (58.5±12.4 vs. 44.9±12.4, p=0.002). Those with and without AF were similar with regard to transmitral gradients, mitral valve area, EF.
In the group with MVA>1.5 cm2, presence of AF influenced physical functioning subscale of SF-36 such that physical functioning score of those with AF was 19±5, whereas, physical functioning score of those without AF was 24±4 (p=0.004). This also resulted in nonsignificant difference in total SF-36 score as well (90±14 vs. 98±16 respectively, p=0.078). Also in this subgroup, those with AF were older compared to those without AF (55.8±9.1 vs. 43.9±16.4 years, p=0.003). Of note, transmitral gradients, MVA, EF were similar again in those with and without AF.
It seems presence of AF influences quality of life with regard to severity of MVA. In those with significant mitral stenosis (MVA ≤1.5 cm2), presence or absence of AF seems not to influence quality of life, whereas, in those with milder forms of mitral stenosis presence of AF seems to worsen physical functioning.