Prognostic and therapeutic implications of pulmonary hypertension complicating degenerative mitral regurgitation due to flail leaflet: A Multicenter Long-term International Study
Open Access
- 8 September 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 32 (6), 751-759
- https://doi.org/10.1093/eurheartj/ehq294
Abstract
To determine the frequency, predictors, and outcome implications of pulmonary hypertension (PH) diagnosed by Doppler echocardiography in a large cohort of patients with the homogenous diagnosis of degenerative mitral regurgitation (MR) due to flail leaflets. The Mitral Regurgitation International DAtabase (MIDA) is a registry including patients with MR due to flail leaflets consecutively referred at tertiary centres in Europe and the USA. Between 1987 and 2004, pulmonary artery systolic pressure (PASP) was measured at baseline by Doppler echocardiography in 437 patients (age 67 ± 11 years; 66% men). Pulmonary hypertension (PASP > 50 mmHg) was observed in 102 patients (23%). Independent predictors of PH were age and left atrial size (P < 0.0001). During a mean follow-up of 4.8 ± 2.8 years, PH was a strong independent predictor of death [adjusted HR 2.03 (1.30–3.18) P = 0.002], cardiovascular death [CVD; adjusted HR 2.21 (1.30–3.76) P = 0.003], and heart failure [adjusted HR 1.70 (1.10–2.62) P = 0.018]. Mitral valve surgery at any time during follow-up (performed in 325 patients, 75%) was beneficial [adjusted HR for death 0.22 (0.14–0.36) P < 0.001], but PH was associated with the increased risk of postoperative death and CVD (P = 0.01). Pulmonary hypertension is a frequent complication of significant MR due to flail leaflet and is associated with major outcome implications, approximately doubling the risk of death and heart failure after diagnosis. Mitral valve surgery performed during follow-up is beneficial but does not completely abolish the adverse effects of PH once it is established and is particularly beneficial in patients without PH. These data support relieving PH secondary to MR due to flail leaflet, but also careful consideration for mitral surgery before PH is established.Keywords
This publication has 40 references indexed in Scilit:
- Comparison of Early Surgery Versus Conventional Treatment in Asymptomatic Severe Mitral RegurgitationCirculation, 2009
- ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart DiseaseCirculation, 2006
- Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of CardiologyEuropean Heart Journal, 2006
- Guidelines for the Management of Patients With Valvular Heart DiseaseCirculation, 1998
- Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performanceThe American Journal of Cardiology, 1994
- Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease.Circulation, 1990
- Isolated chronic mitral regurgitation with preserved systolic left ventricular function and severe pulmonary hypertensionJournal of the American College of Cardiology, 1989
- Mitral regurgitation: relationship of noninvasive descriptors of right and left ventricular performance to clinical and hemodynamic findings and to prognosis in medically and surgically treated patients.Circulation, 1986
- Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave doppler ultrasoundJournal of the American College of Cardiology, 1985
- Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation.Cell Metabolism, 1984