Impact of exercise pulmonary hypertension on posteoperative outcome in primary mitral regurgitation

Authors: Magne, Julien; Donal, Erwan; Mahjoub, Haïfa; Miltner, Beatrice; Dulgheru, Racula; Thebault, Christophe; Pierard, Luc A.; Pibarot, Philippe; Lancellotti, Patrizio
Abstract: Aims: The management of asymptomatic patients with mitral regurgitation (MR) remains controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid onset of symptoms. We hypothesised that ExPHT is a predictor of postoperative cardiovascular events in patients with primary MR. Methods and results: One hundred and two patients with primary MR, no or mild symptoms (New York heart association (NYHA) =2), and no LV dysfunction/dilatation, were prospectively recruited in 3 centres and underwent exercise-stress echocardiography. The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60 mm Hg. All patients were closely followed up and operated on when indication for surgery was reached. Postoperative events were defined as the occurrence of atrial fibrillation (AF), stroke, cardiac-related hospitalisation or death. Among the 102 patients included, 59 developed ExPHT (58%). These patients were significantly older than those without ExPHT (p=0.01). During a mean postoperative follow-up of 50±23 months, 28 patients (26%) experienced a predefined cardiovascular event. Patients with ExPHT had significantly higher rate of postoperative events (39% vs 12%, p=0.005); the rate of events was still higher in these patients (32% vs 9%, p=0.013), even when excluding early postoperative AF (ie, within 48 h). Event-free survival was significantly lower in the ExPHT group (all events: 5-year: 60±8% vs 88±5%, p=0.007, events without early AF: 5-year: 67±7% vs 90±4%, p=0.02). Using Cox multivariable analysis, ExPHT remained independently associated with higher risk of postoperative events in all models (all p=0.04). Conclusions: ExPHT is associated with increased risk of adverse cardiac events following mitral valve surgery in patients with primary MR.
Document Type: Article de recherche
Issue Date: 5 March 2015
Open Access Date: Restricted access
Document version: VoR
This document was published in: Heart, Vol. 101 (5), 391–396 (2015)
BMJ Pub. Group
Alternative version: 10.1136/heartjnl-2014-306296
Collection:Articles publiés dans des revues avec comité de lecture

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