Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis
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...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Hellenic Journal of Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1109966622001178 |
| _version_ | 1797857723202666496 |
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| author | Qi Zhuang Siah Bao Yu Pang Tiffany TS. Ye Jamie SY. Ho Yao Hao Teo Yao Neng Teo Nicholas LX. Syn Benjamin YQ. Tan Raymond CC. Wong Leonard LL. Yeo Edward CY. Lee Tony YW. Li Kian-Keong Poh William KF. Kong Tiong-Cheng Yeo Ping Chai Ching-Hui Sia |
| author_facet | Qi Zhuang Siah Bao Yu Pang Tiffany TS. Ye Jamie SY. Ho Yao Hao Teo Yao Neng Teo Nicholas LX. Syn Benjamin YQ. Tan Raymond CC. Wong Leonard LL. Yeo Edward CY. Lee Tony YW. Li Kian-Keong Poh William KF. Kong Tiong-Cheng Yeo Ping Chai Ching-Hui Sia |
| author_sort | Qi Zhuang Siah |
| collection | DOAJ |
| description | 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, was 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. |
| first_indexed | 2024-04-09T21:01:24Z |
| format | Article |
| id | doaj.art-f5678bcd061a4600b87d4872c3eac776 |
| institution | Directory Open Access Journal |
| issn | 1109-9666 |
| language | English |
| last_indexed | 2024-04-09T21:01:24Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hellenic Journal of Cardiology |
| spelling | doaj.art-f5678bcd061a4600b87d4872c3eac7762023-03-29T09:25:10ZengElsevierHellenic Journal of Cardiology1109-96662023-03-01708084Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysisQi Zhuang Siah0Bao Yu Pang1Tiffany TS. Ye2Jamie SY. Ho3Yao Hao Teo4Yao Neng Teo5Nicholas LX. Syn6Benjamin YQ. Tan7Raymond CC. Wong8Leonard LL. Yeo9Edward CY. Lee10Tony YW. Li11Kian-Keong Poh12William KF. Kong13Tiong-Cheng Yeo14Ping Chai15Ching-Hui Sia16School of Medicine, Cardiff University, Wales, United KingdomPrince Charles Hospital, Cwm Taf Morgannwg University Health Board, Wales, United KingdomSchool of Medicine, Cardiff University, Wales, United KingdomAcademic Foundation Year Programme, North Middlesex Hospital University Trust, London, United KingdomDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeCorresponding author. Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, 119228, Singapore. Tel: +65 6779 5555, Fax: +65 6872 2998.; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, SingaporeBackground: 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, was 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.http://www.sciencedirect.com/science/article/pii/S1109966622001178Mitral stenosis (MS)ischaemic strokeincidence |
| spellingShingle | Qi Zhuang Siah Bao Yu Pang Tiffany TS. Ye Jamie SY. Ho Yao Hao Teo Yao Neng Teo Nicholas LX. Syn Benjamin YQ. Tan Raymond CC. Wong Leonard LL. Yeo Edward CY. Lee Tony YW. Li Kian-Keong Poh William KF. Kong Tiong-Cheng Yeo Ping Chai Ching-Hui Sia Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis Hellenic Journal of Cardiology Mitral stenosis (MS) ischaemic stroke incidence |
| title | Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis |
| title_full | Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis |
| title_fullStr | Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis |
| title_full_unstemmed | Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis |
| title_short | Incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis: A systematic review and meta-analysis |
| title_sort | incidence of acute cerebrovascular events in patients with rheumatic or calcific mitral stenosis a systematic review and meta analysis |
| topic | Mitral stenosis (MS) ischaemic stroke incidence |
| url | http://www.sciencedirect.com/science/article/pii/S1109966622001178 |
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