Pulmonary Hypertension in Aortic and Mitral Valve Disease

Maeder, Micha T.; Weber, Lukas; Buser, Marc; Gerhard, Marc; Haager, Philipp K.; Maisano, Francesco; Rickli, Hans

doi:10.3389/fcvm.2018.00040

Cited by 88 publications

(96 citation statements)

References 84 publications

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“…While the associations between BNP and single haemodynamic parameters were moderately strong, the presence of CpcPH outperformed all these parameters in the multivariate analysis. The AUC for BNP for the prediction of CpcPH was 0.88, which is attractive for a blood biomarker because the non‐invasive assessment of pulmonary hypertension and the underlying haemodynamic mechanisms are notoriously challenging, and right heart catheterization only can definitely reveal the haemodynamic constellation. The definition of CpcPH is based on several parameters, i.e.…”

Section: Discussionmentioning

confidence: 99%

Relationship between B‐type natriuretic peptide and invasive haemodynamics in patients with severe aortic valve stenosis

et al. 2020

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AimsIn patients with aortic stenosis (AS), B-type natriuretic peptide (BNP) is a prognostic marker. However, there is little information on the association between BNP and invasive haemodynamics in AS. The aim of the present study was to assess the hitherto not well-defined relationship between BNP and invasive haemodynamics in patients with severe AS undergoing aortic valve replacement (AVR) with a view to understand the link between high BNP and poor prognosis in these patients. In particular, we were interested in the association between BNP and combined pre-capillary and post-capillary pulmonary hypertension (CpcPH). Methods and results BNP was measured in 252 patients (age 74 ± 10 years, 58% male patients) with severe AS [indexed aortic valve area 0.4 ± 0.1 cm 2 /m 2 and left ventricular ejection fraction (LVEF) 57 ± 12%] the day before cardiac catheterization. Patients were followed for a median (interquartile range) period of 3.1 (2.3-4.3) years after surgical (n = 157) or transcatheter (n = 95) AVR. The prevalence of CpcPH (mean pulmonary artery pressure ≥ 25 mmHg, mean pulmonary artery wedge pressure-15 mmHg, and pulmonary vascular resistance > 3 Wood units) was 13%. The median BNP plasma concentration was 188 (78-452) ng/L. The indexed aortic valve area was similar across BNP quartiles (P = 0.21). Independent predictors of higher BNP (ln transformed) included lower haemoglobin (beta = À0.18; P < 0.001), lower LVEF (beta = À0.20; P < 0.001), more severe mitral regurgitation (beta = 0.20; P < 0.001), higher mean pulmonary artery wedge pressure (beta = À0.37; P < 0.001), and higher pulmonary vascular resistance (beta = 0.21; P < 0.001). In a multivariate model with CpcPH rather than its haemodynamic components, CpcPH was independently associated with higher BNP (0.21; P < 0.001). Higher ln BNP was associated with higher mortality [hazard ratio 1.90 (95% confidence interval 1.33-2.71); P < 0.001] in the univariate analysis. Patients in the third and fourth BNP quartiles had a more than six-fold risk of death compared with patients in the first and second quartiles [hazard ratio 6.29 (95% confidence interval 1.86-21.27); P = 0.003]. In the multivariate analysis, lower LVEF [hazard ratio 0.96 (95% confidence interval 0.94-0.99) per 1% increase; P = 0.01] and CpcPH [hazard ratio 4.58 (95% confidence interval 1.89-11.09); P = 0.001] but not BNP were independently associated with mortality. The areas under the receiver operator characteristics curve for BNP for the prediction of CpcPH and mortality were 0.88 and 0.74, respectively. Conclusions In patients with severe AS, higher BNP is a marker of the presence of CpcPH and its contributors. The association between BNP and such an adverse haemodynamic profile at least in part explains the ability of BNP to predict long-term post-AVR mortality.

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Section: Discussionmentioning

confidence: 99%

Relationship between B‐type natriuretic peptide and invasive haemodynamics in patients with severe aortic valve stenosis

et al. 2020

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“…Pulmonary hypertension (PH) due to left heart disease is the most common form of PH . In patients with severe aortic stenosis (AS), PH is frequent and a marker of poor prognosis . However, the majority of data on PH in AS patients are derived from echocardiography studies, where systolic pulmonary artery pressure (PAP) is estimated by measurement of peak tricuspid regurgitation velocity.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic mechanisms and long‐term prognostic impact of pulmonary hypertension in patients with severe aortic stenosis undergoing valve replacement

Weber

Rickli

Haager

et al. 2018

European J of Heart Fail

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Aims We aimed to investigate the prevalence, detailed invasive haemodynamics, and prognostic impact of pulmonary hypertension (PH) in severe aortic stenosis (AS). Methods and results We studied 503 patients (mean age 74 ± 10 years) with severe AS (indexed aortic valve area 0.4 ± 0.1 cm2/m2, left ventricular ejection fraction 57 ± 12%) undergoing left and right heart catheterization prior to aortic valve replacement. Median follow‐up was 3.7 (interquartile range 2.6–5.4) years. Baseline PH (mean pulmonary artery pressure ≥ 25 mmHg) was found in 239 (48%) patients: 31 patients had pre‐capillary PH [mean pulmonary artery wedge pressure (mPAWP) ≤ 15 mmHg], 144 had isolated post‐capillary PH [IpcPH; mPAWP > 15 mmHg, pulmonary vascular resistance (PVR) ≤ 3 Wood units (WU)], and 64 had combined pre‐ and post‐capillary PH (CpcPH; mPAWP > 15 mmHg, PVR > 3 WU). Patients with CpcPH had higher mortality than those with IpcPH, pre‐capillary PH, and without PH. In the multivariate analysis, CpcPH remained an independent predictor of death (hazard ratio 4.39, 95% confidence interval 2.40–8.03; P < 0.001). Patients with CpcPH had higher mPAWP (26 ± 7 vs. 22 ± 5 mmHg) and lower pulmonary arterial capacitance (1.5 ± 0.6 vs. 2.9 ± 1.2 mL/mmHg) than IpcPH patients but similar left ventricular end‐diastolic pressure (LVEDP; 25 ± 7 vs. 25 ± 7 mmHg). A smaller LVEDP–mPAWP difference was related to larger left atrial size, atrial fibrillation, and more severe mitral regurgitation. Conclusions In patients with severe AS, PH is common but underlying mechanisms differ. Patients with CpcPH have higher mPAWP, lower pulmonary arterial capacitance, and worse survival than all other groups. Left atrial dysfunction and mitral regurgitation seem to be drivers of high mPAWP in CpcPH.

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“…20 The increase of pulmonary artery pressure often occurs in both mitral stenosis and mitral regurgitation, and the presence of pulmonary arterial hypertension (PAH) in mitral valve disease is also key to determine the best treatment. 21,22 PAH can be occurred due to an increase in left atrial pressure which can be developed into pulmonary venous hypertension and subsequent pulmonary arterial hypertension. IE that has developed into mitral valve disease will increase the risk of PAH, and the risk can be reduced by eliminating the disease in the mitral valve.…”

Section: Discussionmentioning

confidence: 99%

Infective endocarditis as a morbidity predictor in patients who underwent mitral valve surgery

2019

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Infective endocarditis (IE) often develops into rheumatic heart disease (RHD) that has many perioperative complications during the evolution of the disease. Cardiac surgery in patients with IE is often followed by postoperative morbidities that can decrease the quality of life. This study aimed to investigate the correlations between preoperative IE and the emergence of various morbidities in patients undergoing heart valve surgery. This was a cross-sectional study with secondary data analysis of the medical record in 60 patients with mitral valve surgery at Dr. Sardjito General Hospital, Yogyakarta from 2012 to 2017. As much as 30 of 60 patients were suffered IE before mitral valve surgery. The most common valve disease in the IE group was mitral stenosis (60%). IE was significantly associated with arrhythmia and cardiac event with p=0.002 (PR: 6.91), prolonged ICU stay with p=0.011 (PR: 5.68), prolonged ventilator use with p=0.015 (PR: 12.43) and severe pulmonary arterial hypertension (PAH) with p=0.033 (PR: 0.192) post mitral valve surgery. As many as 26 (87%) and 29 (96.7%) of patients with IE had a prolonged ICU stay and prolonged ventilator after mitral valve surgery respectively. The incidence of severe PAH postoperatively in the IE group was lower than in the non-IE group (10% vs 36.7%). IE was significantly associated with the increased risk of arrhythmia, prolonged ventilator use and prolonged ICU stay after mitral valve surgery.

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Pulmonary Hypertension in Aortic and Mitral Valve Disease

Cited by 88 publications

References 84 publications

Relationship between B‐type natriuretic peptide and invasive haemodynamics in patients with severe aortic valve stenosis

Relationship between B‐type natriuretic peptide and invasive haemodynamics in patients with severe aortic valve stenosis

Haemodynamic mechanisms and long‐term prognostic impact of pulmonary hypertension in patients with severe aortic stenosis undergoing valve replacement

Infective endocarditis as a morbidity predictor in patients who underwent mitral valve surgery

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