Hemodynamic characteristics and procedural outcome of patients with mitral stenosis and a depressed cardiac output

The patient with mitral stenosis (MS) may note symptoms of pulmonary congestion (dyspnea, orthopnea, and paroxysmal nocturnal dyspnea) and/or a depressed cardiac output (fatigue). 1 Pulmonary congestion is caused by an elevated left atrial pressure and can be alleviated or improved by a diuretic-induced shrinkage of intravascular volume. Although diuresis lowers left atrial pressure, thereby lessening pulmonary congestion, it may lead to an inadequate cardiac output, with resultant fatigue. Therefore, in some subjects with MS, the administration of diuretics causes a resolution of one constellation of symptoms (those of pulmonary congestion) but the appearance of another (those of a low cardiac output). Over the last 20 years, we have observed a group of patients with MS whose initial symptom was fatigue and whose cardiac output was depressed in the absence of previous or present diuretic therapy. It was our practice to manage these patients in a fashion similar to other patients with MS, referring them for surgical or percutaneous intervention because of symptoms despite medical therapy. However, there are no published data indicating if they would survive the procedure and derive symptomatic improvement from it. Therefore, this study was performed (1) to characterize this subgroup of patients hemodynamically and to compare their hemodynamic data with those of patients with MS of similar severity in the presence of a diuretic-induced low cardiac output, and (2) to assess procedure-related mortality and symptomatic response to intervention in those with MS and a spontaneously depressed cardiac output.