Mitral valve stenosis (MVS) remains a significant cause of cardiovascular morbidity, particularly in developing regions where rheumatic heart disease persists as a major contributor (1). The pathological narrowing of the mitral valve orifice leads to increased left atrial pressure, pulmonary hypertension, and eventual right heart dysfunction if left untreated (2). While the natural history of MVS has been well documented, the presence of comorbid systemic illnesses, such as chronic kidney disease (CKD), may alter its progression and clinical outcomes.

CKD is a global health burden affecting approximately 10% of the adult population and is associated with a wide spectrum of cardiovascular complications (3). Patients with CKD often exhibit accelerated valvular calcification, systemic inflammation, and endothelial dysfunction, all of which may negatively impact valvular heart diseases including MVS (4,5). Several studies have reported an increased prevalence of valvular abnormalities in CKD patients, particularly mitral annular calcification and leaflet thickening (6,7). However, the direct influence of CKD on the progression and prognosis of MVS has not been thoroughly elucidated.

Understanding the interplay between renal dysfunction and mitral valvular disease is essential, given the overlapping pathophysiological mechanisms and their cumulative effect on cardiac remodeling and hemodynamics (8). This study was undertaken to assess the impact of CKD on the echocardiographic progression and clinical outcomes of patients diagnosed with mitral valve stenosis over a one-year follow-up period.

tudy Design and Setting

This was a prospective observational study conducted over a period of 12 months at a tertiary care center. The study received ethical clearance from the Institutional Ethics Committee, and informed consent was obtained from all participants.

Study Population

A total of 120 adult patients diagnosed with rheumatic mitral valve stenosis (MVS) were enrolled. Patients were divided into two groups based on the presence or absence of chronic kidney disease (CKD):

• Group A: 60 patients with CKD (Stages 3 to 5, based on estimated glomerular filtration rate <60 mL/min/1.73 m²)
• Group B: 60 patients without CKD (eGFR ≥ 60 mL/min/1.73 m²)

Exclusion criteria included patients with more than mild mitral regurgitation, presence of other significant valvular lesions, history of valve replacement or balloon valvotomy, acute kidney injury, and patients with systemic diseases such as active infection, malignancy, or autoimmune disorders.

Clinical and Echocardiographic Evaluation

All participants underwent a comprehensive clinical assessment and transthoracic echocardiography (TTE) at baseline and at the end of 12 months. Echocardiographic parameters recorded included mitral valve area (MVA) using pressure half-time method, mean transmitral gradient, left atrial size, and pulmonary artery systolic pressure (PASP) estimated via tricuspid regurgitation velocity. The progression of MVS was evaluated based on changes in MVA and transmitral gradient.

Renal Function Assessment

Serum creatinine levels were measured, and eGFR was calculated using the CKD-EPI formula. CKD staging was done in accordance with Kidney Disease Improving Global Outcomes (KDIGO) guidelines.

Follow-Up and Outcomes

Patients were followed up at 3-month intervals for a total of 12 months. Major adverse cardiovascular events (MACE), including hospitalization for heart failure, new-onset atrial fibrillation, stroke, or cardiac death, were documented.

Statistical Analysis

Data analysis was performed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation and compared using the independent t-test or Mann–Whitney U test, as appropriate. Categorical variables were expressed as percentages and compared using the chi-square test. A p-value of <0.05 was considered statistically significant.

A total of 120 patients diagnosed with mitral valve stenosis were enrolled, with 60 patients each in the CKD (Group A) and non-CKD (Group B) groups. The mean age of participants in Group A was 58.2 ± 8.6 years, while it was 55.9 ± 9.3 years in Group B. Females constituted 62% of the overall study population, with no significant difference between the groups.

Echocardiographic Findings at Baseline and 12 Months
At baseline, the mitral valve area (MVA) and transmitral gradient were comparable between both groups. However, after 12 months, Group A showed a significantly greater reduction in MVA and increase in pulmonary artery systolic pressure (PASP) compared to Group B. The detailed echocardiographic parameters are shown in Table 1.

Table 1. Comparison of Echocardiographic Parameters Between CKD and Non-CKD Groups

As shown in Table 1, CKD patients experienced a more rapid progression of mitral stenosis and worsening pulmonary pressures compared to those without CKD (p < 0.05).

Adverse Cardiovascular Events

The incidence of major adverse cardiovascular events (MACE) during the 12-month follow-up was significantly higher in Group A (30%) compared to Group B (12%). Hospitalizations due to heart failure and new-onset atrial fibrillation were the most common events in the CKD group (Table 2).

Table 2. Incidence of Major Adverse Cardiovascular Events (MACE)

As illustrated in Table 2, patients with CKD were at significantly greater risk of experiencing MACE (p = 0.01), underscoring the clinical importance of renal function in patients with MVS.

The present study demonstrates that chronic kidney disease (CKD) is associated with a more rapid progression of mitral valve stenosis (MVS) and poorer cardiovascular outcomes over a 12-month follow-up period. Patients with CKD showed a greater decline in mitral valve area (MVA), elevated pulmonary pressures, and an increased incidence of major adverse cardiovascular events (MACE) compared to their non-CKD counterparts.

The accelerated decline in MVA among CKD patients may be attributed to the chronic inflammatory milieu, mineral metabolism abnormalities, and enhanced calcific degeneration of the mitral valve apparatus commonly seen in renal dysfunction (1,2). Studies have reported that patients with CKD, particularly in advanced stages, exhibit early and extensive valvular calcification, even in the absence of significant atherosclerotic burden (3,4). This calcification, especially at the mitral annulus, may contribute to both stenotic and regurgitant valvular lesions (5).

Moreover, CKD-induced endothelial dysfunction and systemic oxidative stress may also accelerate rheumatic valve remodeling and leaflet fibrosis (6,7). The increase in pulmonary artery systolic pressure (PASP) noted in our study in CKD patients aligns with prior findings suggesting a strong association between renal impairment and pulmonary hypertension (8). This is likely due to fluid overload, left atrial hypertension, and stiffening of pulmonary vasculature secondary to uremic toxins (9,10).

The significantly higher rate of MACE, particularly heart failure and atrial fibrillation, in the CKD group emphasizes the broader cardiovascular vulnerability in this population (11,12). Left atrial enlargement and elevated filling pressures in mitral stenosis, compounded by CKD-related myocardial fibrosis and diastolic dysfunction, may predispose patients to arrhythmias and hemodynamic instability (13). Additionally, neurohormonal activation and impaired volume regulation in CKD can worsen heart failure outcomes (14).

While mitral valve interventions such as percutaneous balloon mitral valvotomy remain effective in selected patients, CKD poses a challenge in terms of procedural risk and long-term prognosis (15). Therefore, early detection and multidisciplinary management of MVS in CKD patients are essential to delay progression and improve outcomes.

Limitations

Of the study include a relatively short follow-up period and lack of advanced imaging modalities such as cardiac CT or 3D echocardiography to assess calcification. Furthermore, the single-center design may limit generalizability.

chronic kidney disease significantly accelerates the progression of mitral valve stenosis and worsens clinical outcomes. Patients with CKD are at higher risk for increased pulmonary pressures and adverse cardiovascular events. Early detection and multidisciplinary management are essential to improve prognosis in this high-risk group.

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