Updated Wilkins Score Predicting Success of Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis

Abstract

Background The Wilkins score evaluates mitral valve morphology and predicts percutaneous balloon mitral valvuloplasty (PBMV) success in rheumatic mitral stenosis (MS). The 2021 European Society of Cardiology guidelines recommend considering 5 clinical and 2 anatomical factors when selecting PBMV candidates. Objectives The authors aimed to update the Wilkins score by integrating clinical variables and compared its performance with the conventional score. Methods We studied 1,128 patients with rheumatic MS who underwent PBMV in 4 hospitals. PBMV success was defined as postprocedural mitral valve area (MVA) ≥1.5 cm², irrespective of percentage increase, mitral regurgitation ≤ grade 2, with no more than a 1-grade increment in severity and without in-hospital complications. The Wilkins-Integrated Clinical PBMV score was developed from a multivariable logistic regression predicting PBMV success, incorporating age, prior commissurotomy, NYHA functional class IV, atrial fibrillation, right ventricular systolic pressure, pre-PBMV MVA, severe tricuspid regurgitation, and Wilkins score. Results The median age was 45 years and 82.2% were female. Prevalence of prior commissurotomy, NYHA functional class IV, atrial fibrillation, and pulmonary hypertension was 4.3%, 1.5%, 48.4%, and 44.5%, respectively. The median Wilkins score was 8 and 65.8% and 4.2% had very small MVA and severe tricuspid regurgitation. The procedural success rate was 48.6%. C-statistic of the Wilkins score and the Wilkins-Integrated Clinical PBMV score was 0.543 (95% CI: 0.477-0.608) and 0.658 (95% CI: 0.595-0.721), respectively. The Wilkins-Integrated Clinical PBMV score showed good calibration and clinical utility on decision curve analysis. Conclusions The Wilkins-Integrated Clinical PBMV score better predicts procedural success in patients with rheumatic MS who underwent PBMV.