The Right Heart-Pulmonary Circulation Unit and Left Heart Valve Disease

Abstract

Valvular heart disease (VHD) is frequently accompanied by pulmonary hypertension (PH). In asymptomatic patients, PH is rare, although the exact prevalence is unknown and mainly stems from the severity of the VHD and the presence of diastolic dysfunction. PH can also be depicted during exercise echocardiography. PH either at rest or during exercise is also a powerful determinant of outcome and is independently associated with reduced survival, regardless of the severity of the underlying valvular pathology. Therefore, because PH is a marker of poor prognosis, assessment of PH in VHD is crucial for risk stratification and management of patients with VHD.

Exercise Pulmonary Hypertension in Heart Valve Disease

“…The presence of resting PH 50 mmHg correlates with poor prognosis in patients undergoing mitral valve (MV) surgery (as summarized in Table 1 , Ref. [ 6 , 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]), increasing the likelihood of continued post-operative symptoms by 2 fold. However, early surgery still provides the best opportunity for patients to improve their quality of life in those patients with PH at rest.…”

“… Adapted from Filippetti L et al . [ 14 ], “The Right Heart Pulmonary Circulation Unit and Left Heart Valve Disease”. PH, pulmonary hypertension; sPAP, systolic pulmonary arterial hypertension; CI, confidence interval; eRVSP, estimated right ventricle systolic pressure; HR, hazard ratio; aHR, adjusted hazard ratio; TAVR, transcatheter aortic valve replacement; MR, mitral regurgitation; MV, mitral valve.…”

“…Adapted from Filippetti L et al . [ 14 ], “The Right Heart Pulmonary Circulation Unit and Left Heart Valve Disease”.…”

“…Moreover, exercise-PH is associated with significantly lower 2-year symptom-free survival. When stress PH is greater than 60 mmHg, patients should be considered for surgery [ 14 ]. In a cohort of 97 patients with moderate-severe primary MR, PH at peak-exercise was a predictor of the recurrence of symptoms within 2 years [ 24 ].…”

“…In a cohort of 97 patients with moderate-severe primary MR, PH at peak-exercise was a predictor of the recurrence of symptoms within 2 years [ 24 ]. Exercise-PH was estimated to be present in 40% [ 14 ] of patients with functional MR regardless of LV function. The independent determinants of exercise-PH are the occurrence of resting PH, MR severity with exercise, alongside with left ventricular diastolic dysfunction [ 13 ].…”