Value of pulmonary artery pressure in predicting in-hospital and one-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease: an observational study

• Published in: BMJ open Vol. 7; no. 5; p. e014316
• Main Authors: Jiang, Lei, Wei, Xue-biao, He, Peng-cheng, Feng, Du, Liu, Yuan-hui, Liu, Jin, Chen, Ji-yan, Yu, Dan-qing, Tan, Ning
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.05.2017; BMJ Open
• Subjects: Cardiovascular disease; China - epidemiology; Clinical medicine; Coronary Angiography; Echocardiography, Doppler; Family medical history; Female; Heart failure; Heart surgery; Heart Valve Prosthesis Implantation; Hospital Mortality - trends; Humans; Hypertension, Pulmonary - diagnostic imaging; Kaplan-Meier Estimate; Logistic Models; Lung diseases; Male; Medical imaging; Middle age; Middle Aged; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Mortality; Multivariate Analysis; Observational studies; Postoperative Period; Predictive Value of Tests; Pulmonary arteries; Pulmonary Artery - diagnostic imaging; Pulmonary hypertension; Rheumatic fever; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - mortality; Rheumatology; ROC Curve; Suicides & suicide attempts; Variance analysis; New York; United States > US; rheumatic mitral disease; Pulmonary artery pressure; valve replacement surgery
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-014316

ObjectivesTo investigate the role of pulmonary artery pressure (PAP) in predicting in-hospital death after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease.DesignAn observational study.SettingGuangdong General Hospital, China.Participants1639middle-aged and aged patients (mean age 57±6 years) diagnosed with rheumatic mitral disease, undergoing valve replacement surgery and receiving coronary angiography and transthoracic echocardiography before operation, were enrolled.InterventionsAll participants underwent valve replacement surgery and received coronary angiography before operation.Primary and secondary outcome measuresIn-hospital death and 1-year mortality after operation.MethodsIncluded patients were divided into four groups based on the preoperative PAP obtained by echocardiography: group A (PAP≤30 mm Hg); group B (>30 mm Hg<PAP≤50 mm Hg), group C (>50 mm Hg<PAP≤70 mm Hg) and group D (PAP>70 mm Hg). The relationship between PAP and in-hospital death and cumulative rate of 1-year mortality was evaluated.ResultsIn-hospital mortality rate increased gradually but significantly as the PAP level increased, with 1.9% in group A (n=268), 2.3% in group B (n=771), 4.7% in group C (n=384) and 10.2% in group D (n=216) (p<0.001). Multivariate analysis showed that PAP>70 mm Hg was an independent predictor of in-hospital death (OR=2.93, 95% CI 1.61 to 5.32, p<0.001). PAP>52.5 mm Hg had a sensitivity of 60.3% and specificity of 67.7% in predicting in-hospital death (area under the curve=0.672, 95% CI 0.602 to 0.743, p<0.001). Kaplan–Meier analysis showed that patients with PAP>52.5 mm Hg had higher 1-year mortality after operation than those without (log-rank=21.51, p<0.001).ConclusionsPAP could serve as a predictor of postoperative in-hospital and 1-year mortality after valve replacement surgery in middle-aged and aged patients with rheumatic mitral disease.