Prevalence and survival associated with pulmonary hypertension after mitral valve replacement: National echocardiography database of Australia study

Abstract

The specific prevalence and outcome of pulmonary hypertension after mitral valve replacement (MVR) is not well documented. The aim of the study was to determine the prevalence and prognostic impact of pulmonary hypertension after MVR. In addition, we sought to determine the threshold of mortality risk according to echocardiography derived pulmonary pressures and those echocardiographic characteristics that are associated with increased mortality. Using the National Echocardiography Database of Australia, patients who had undergone MVR were identified with estimated right ventricular systolic pressure (eRVSP) assessed and linked to patient mortality during mean follow up of 1917 days. Classification and regression tree analysis was used to identify the most powerful predictors of mortality. A total of 10,994 patients who had undergone echocardiography following MVR (mean age 65.2 ± 16, 44.8% women) were studied (mean follow‐up 1917 days). The prevalence of PH (defined as eRSVP ≥40 mmHg) was 64.1% (7042/10,994). Severe PH (eRVSP ≥60 mmHg) was seen in 42.3% (4671/10,994). Mortality in individuals with PH was greater than amongst individuals without PH (41.1% vs. 26.3%). Age, tricuspid regurgitation and left ventricular dysfunction were also associated with mortality. There is a high prevalence of PH after MVR which confers an adverse prognosis. Improved therapeutic approaches to mitral valve disease and the subsequent development of PH are essential.

Pulmonary Hypertension in Left Ventricular Valvular Diseases: A Comprehensive Review on Pathophysiology and Prognostic Value

“…A large cohort study was conducted in Australia investigating the predictive role of the persistence of PH after MV replacement (MVR) in patients with either MR or MS [ 55 ]. Postoperative PH was observed in 64.1% of patients (7042/10,994), as has been defined by PASP calculated to be above 40 mmHg.…”

“…The prevalence of PH in patients with severe MR ranges from 20–30%, and it increases up to 64% in severe symptomatic patients with New York Heart Association Class (NYHA) III-IV [ 57 ], and further up to 78% in patients requiring mitral valve surgery [ 58 ]. Although resting PH has been recorded in a minority of patients with severe primary asymptomatic MR [ 55 , 59 ], the exercise test can unravel the presence of EIPH in a larger proportion of patients (up to 58%) [ 56 ]. Thus, EIPH is more frequent than resting PH in patients with primary MR and its presence may be related to potential adverse outcomes [ 55 ].…”

“…Although resting PH has been recorded in a minority of patients with severe primary asymptomatic MR [ 55 , 59 ], the exercise test can unravel the presence of EIPH in a larger proportion of patients (up to 58%) [ 56 ]. Thus, EIPH is more frequent than resting PH in patients with primary MR and its presence may be related to potential adverse outcomes [ 55 ].…”

“…Current guidelines comment that ESE is as an additional test in patients with asymptomatic severe MR, which is used to unmask symptoms and detect EIPH [ 51 , 77 , 78 ]. The presence of increased PASP during exercise may be useful for risk stratification and therapeutic management of patients with MR [ 55 , 77 ].…”

Surgical Reconstruction of Mitral Restenosis Complicated by a Critically Small Left Ventricular Cavity and Giant Left and Right Atriomegaly (Clinical Case)

“…fected due to the active remodeling of the critically small LV cavity towards a certain increase in its size already at the hospital stage [8,9,10,11,12,13,14,15]. The conjugal process does not allow to quickly increase the volume of LV, so the size of the mitral mechanical prosthesis (25 mm) is adequate in this clinical situation.…”