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

• Published in: Heart (British Cardiac Society) Vol. 101; no. 5; pp. 391 - 396
• Main Authors: Magne, Julien, Donal, Erwan, Mahjoub, Haifa, Miltner, Beatrice, Dulgheru, Raluca, Thebault, Christophe, Pierard, Luc A, Pibarot, Philippe, Lancellotti, Patrizio
• Format: Journal Article Web Resource
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2015; BMJ Publishing Group
• Subjects: Age Factors; Aged; Asymptomatic Diseases; Atrial Fibrillation; Atrial Fibrillation - epidemiology; Belgium - epidemiology; Cardiology; Cardiovascular & respiratory systems; Cardiovascular disease; Echocardiography, Stress; Female; Follow-Up Studies; France - epidemiology; Heart Atria; Heart Atria - diagnostic imaging; Heart attacks; Heart Failure; Heart Failure - mortality; Heart Ventricles; Heart Ventricles - diagnostic imaging; Hospitalization - statistics & numerical data; Human health sciences; Humans; Hypertension, Pulmonary; Hypertension, Pulmonary - epidemiology; Life Sciences; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Insufficiency - epidemiology; Mitral Valve Insufficiency - surgery; Multivariate Analysis; Postoperative Complications; Postoperative Complications - epidemiology; Prospective Studies; Pulmonary hypertension; Quebec - epidemiology; Santé publique et épidémiologie; Sciences de la santé humaine; Stroke; Stroke - epidemiology; Surgery; Systèmes cardiovasculaire & respiratoire; VALVULAR DISEASE; Workloads; Belgium; VALVULAR DISEASE
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2014-306296

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.