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

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: , 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.