Functional mitral regurgitation : a link to pulmonary hypertension in heart failure with preserved ejection fraction.

Authors: Maréchaux, Sylvestre; Neicu, Dan Valentin; Braun, Sophie; Richardson, Marjorie; Delsart, Pascal; Bouabdallaoui, Nadia; Banfi, Carlo; Gautier, Corinne; Graux, Pierre; Asseman, Philippe; Pibarot, Philippe; Le Jemtel, Thierry H.; Ennezat, Pierre Vladimir
Abstract: Background: Patients with heart failure with preserved ejection fraction (HFpEF) may present with Pulmonary hypertension (PH) and functional mitral regurgitation (MR). Whether PH is linked to the presence of functional MR has not been investigated in HFpEF patients. Methods and Results: Systolic pulmonary artery pressure (sPAP) and functional MR were assessed by 2-dimensional Doppler echocardiography in 70 ambulatory HFpEF patients and 70 hypertensive control subjects free of organic mitral valve lesions, significant valve disease, and comorbid conditions associated with PH. Whereas none of control subjects had more than trivial MR, 21 patients with HFpEF had functional MR (mean mitral effective regurgitant orifice, regurgitant volume, and regurgitant fraction 7 ± 3 mm,2 15 ± 8 mL, and 28 ± 14%, respectively). Pulmonary hypertension (sPAP > 35 mm Hg) was significantly more prevalent in HFpEF patients with functional MR than in HFpEF patients without functional MR (62 vs 22%; P = .002). Functional MR remained an independent predictor of PH in HFpEF patients (P = .004) after adjustment on mitral E wave to e0 mitral annulus velocity ratio (E/e0; P = .022) and left atrial volumeindex (P = .025). SystolicPAPand E/e0 were greater inHFpEFpatients than in control subjects (35 ± 9 vs 29 ± 8mmHg [P < .0001] and 13 ± 6vs11 ± 5 [P = .018], respectively). Systolic PAPremained greater in HFpEF patients than in control subjects after adjusting for E/e0 (P = .002). Conclusions: Pulmonary hypertension appears to be linked to the presence of functional MR in HFpEF patients.
Document Type: Article de recherche
Issue Date: 1 October 2011
Open Access Date: Restricted access
Document version: VoR
This document was published in: Journal of cardiac failure, Vol. 17 (10), 806–812 (2011)
Churchill Livingstone
Alternative version: 10.1016/j.cardfail.2011.05.013
Collection:Articles publiés dans des revues avec comité de lecture

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