The prognostic value of exercise-induced pulmonary hypertension in asymptomatic patients with primary mitral regurgitation

Kadoglou, Nikolaos P.E.; Papadopoulos, Constantinos; Krommydas, Argyris

doi:10.1016/j.jjcc.2021.09.016

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…The interplay between HFpEF and HHD is complex. Both are characterized by exertional dyspnea and effort intolerance due to elevated LV filling pressure [76,79]. HFpEF may not be clinically apparent, posing challenges to diagnosis based solely on symptoms and standard evaluations.…”

Section: Stress Echocardiographymentioning

confidence: 99%

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

Kadoglou,

Mouzarou,

Hadjigeorgiou

et al. 2024

JCM

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It has been well established that arterial hypertension is considered as a predominant risk factor for the development of cardiovascular diseases. Despite the link between arterial hypertension and cardiovascular diseases, arterial hypertension may directly affect cardiac function, leading to heart failure, mostly with preserved ejection fraction (HFpEF). There are echocardiographic findings indicating hypertensive heart disease (HHD), defined as altered cardiac morphology (left ventricular concentric hypertrophy, left atrium dilatation) and function (systolic or diastolic dysfunction) in patients with persistent arterial hypertension irrespective of the cardiac pathologies to which it contributes, such as coronary artery disease and kidney function impairment. In addition to the classical echocardiographic parameters, novel indices, like speckle tracking of the left ventricle and left atrium, 3D volume evaluation, and myocardial work in echocardiography, may provide more accurate and reproducible diagnostic and prognostic data in patients with arterial hypertension. However, their use is still underappreciated. Early detection of and prompt therapy for HHD will greatly improve the prognosis. Hence, in the present review, we shed light on the role of echocardiography in the contemporary diagnostic and prognostic approaches to HHD.

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Section: Stress Echocardiographymentioning

confidence: 99%

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

Kadoglou,

Mouzarou,

Hadjigeorgiou

et al. 2024

JCM

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“…In asymptomatic patients with MR without LV abnormalities, ESE may unmask symptoms or identify a proportion of patients who are at higher risk of developing symptoms and who will benefit from early intervention. In a recent study of asymptomatic patients with primary MR, the early rise in PASP during exercise was a significant predictor of symptom occurrence and morbidity within one year, with an important proportion of them requiring surgical replacement [ 60 ]. A recent study in patients with MR following the watchful waiting strategy demonstrated poorer prognosis in those with EIPH, compared to those without EIPH [ 61 ].…”

Section: Potential Clinical Applicationsmentioning

confidence: 99%

Exercise-Induced Pulmonary Hypertension: A Valid Entity or Another Factor of Confusion?

Khattab

Velidakis²,

Gkougkoudi³

et al. 2023

Life

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Exercise-induced pulmonary hypertension EIPH has been defined as an increase in mean pulmonary arterial pressure (mPAP) during exercise in otherwise normal values at rest. EIPH reflects heart and/or lung dysfunction and may precede the development of manifest pulmonary hypertension (PH) in a proportion of patients. It is also associated with decreased life expectancy in patients with heart failure with reduced ejection fraction (HFrEF) or left ventricle (LV) valvular diseases. Diastolic dysfunction exacerbated during exercise relates to increased LV filling pressure and left atrial pressure (LAP). In this context backward, transmitted pressure alone or accompanied with backward blood flow promotes EIPH. The gold standard of EIPH assessment remains the right heart catheterization during exercise, which is an accurate but invasive method. Alternatively, non-invasive diagnostic modalities include exercise stress echocardiography (ESE) and cardiopulmonary exercise testing (CPET). Both diagnostic tests are performed under gradually increasing physical stress using treadmill and ergo-cycling protocols. Escalating workload during the exercise is analogous to the physiological response to real exercise. The results of the latter techniques show good correlation with invasive measurements, but they suffer from lack of validation and cut-off value determination. Although it is not officially recommended, there are accumulated data supporting the importance of EIPH diagnosis in the assessment of other mild/subclinical or probably fatal diseases in patients with latent PH or heart failure or LV valvular disease, respectively. Nevertheless, larger, prospective studies are required to ensure its role in clinical practice.

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“…There is a consensus that PASP ≥ 60 mmHg during exercise is an important cut-off value with a negative prognostic significance in patients with severe MR [ 69 , 72 , 73 ]. In the past American College of Cardiology/American Heart Association guidelines, exercise-induced PASP ≥ 55 mmHg was considered a Class IIa indication for intervention in asymptomatic patients with MR [ 58 ].…”

Section: Left Ventricle Valvular Diseases and Pulmonary Hypertensionmentioning

confidence: 99%

“…Thus, the assessment of PASP only at low workload, which is easily obtained, may be adequate and clinically applicable [ 77 ]. Overall EIPH is considered a predictor of low survival and symptoms occurrence [ 70 , 71 , 72 ]. Importantly, it seems that an early rise of PASP during mild exercise is a significant predictor of symptoms’ development and morbidity in the short-term follow-up [ 40 ].…”

Section: Left Ventricle Valvular Diseases and Pulmonary Hypertensionmentioning

confidence: 99%

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

Velidakis,

Khattab,

Gkougkoudi

et al. 2023

Life

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Left ventricular (LV) valvular diseases, make up one of the most common etiologies for pulmonary hypertension (PH), and it is not well understood how and at which degree it affects prognosis. The aim of the present study was a comprehensive review of the pathophysiologic mechanism of PH in patients with LV valvular diseases and the prognostic value of baseline and post-intervention PH in patients undergoing interventional treatment. The pathophysiology of PH in patients with LV valvular diseases involves gradual elevation of left ventricular filling pressure and left atrial pressure, which are passively transmitted to the pulmonary circulation and raise pulmonary artery systolic pressure (PASP). A long-lasting exposure to elevated PASP progressively leads to initially functional and thereafter irreversible structural changes in the pulmonary vasculature, leading up to high pulmonary vascular resistance. Surgical treatment of severe LV valvular diseases is highly effective in patients without resting PH or those with exercise-induced PH (EIPH) before intervention. In the case of pre-operative PH, successful interventional therapy decreases PASP, but the post-operative cardiac and all-cause mortality remain higher compared to patients without pre-operative PH. Hence, it is of paramount importance to detect patients with severe LV valvulopathies before the development of PH, since they will get greater benefits from early intervention.

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The prognostic value of exercise-induced pulmonary hypertension in asymptomatic patients with primary mitral regurgitation

Cited by 7 publications

References 15 publications

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

Exercise-Induced Pulmonary Hypertension: A Valid Entity or Another Factor of Confusion?

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

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