Combined pre- and post-capillary pulmonary hypertension detected by RHC prior to mitral valve procedure was associated with a more than 10-fold higher risk (OR 10.66, 95% CI 4.05–28.03) of high pulmonary hypertension probability at 3-month follow-up compared to no baseline PH.
Observational (n=274)
No
Does baseline hemodynamic classification by right heart catheterization predict the probability of pulmonary hypertension several months after mitral valve repair/replacement in patients with mitral regurgitation?
In patients with mitral regurgitation, baseline invasive hemodynamic profiling using the 2022 ESC/ERS definition strongly predicts the probability of persistent pulmonary hypertension after mitral valve repair or replacement.
Effect estimate: OR 10.66 for combined pre- and post-capillary PH vs no PH (95% CI 95% CI 4.05–28.03)
p-value: p=<0.001
ABSTRACT In patients with mitral regurgitation (MR), the role of invasive hemodynamics is not well defined. We evaluated the value of right heart catheterization (RHC) and the 2022 ESC/ERS pulmonary hypertension (PH) definition prior to a mitral valve procedure for the prediction of PH several months thereafter. We studied 274 patients (mean age 68 ± 11 years) with at least moderate MR (84% degenerative, 11% functional, 5% combined) undergoing RHC (baseline) followed by surgical (70%) or transcatheter (30%) valve repair/replacement who had an echocardiogram after a median follow‐up of 3 months. PH was defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg and was subclassified by mean pulmonary artery wedge pressure (mPAWP) and pulmonary vascular resistance (PVR). The PH follow‐up probability was assessed by peak tricuspid regurgitant velocity and indirect PH signs. At baseline, 143/274 (52%) patients had any PH: 40 had isolated post‐capillary, 65 had combined pre‐ and post‐capillary (CpcPH), 27 had pre‐capillary, and 11 had unclassified PH. Follow‐up PH probability was low in 149, intermediate in 73, or high in 42 patients. There was a progressive increase in baseline mPAP, mPAWP, and PVR ( p < 0.001 for all) in patients with low, intermediate or high follow‐up PH probability. Patients with baseline CpcPH had a nearly 11‐fold higher risk (odds ratio 10.7) for a high follow‐up PH probability compared to those without PH. In conclusion, in MR patients the hemodynamic constellation according to the 2022 ESC/ERS PH definition predicts the PH probability several months after a mitral valve procedure.
Güpfert et al. (Thu,) conducted a observational in Adults (mean age 68 ± 11 years) with at least moderate mitral regurgitation undergoing surgical or transcatheter mitral valve repair/replacement (n=274). Right heart catheterization with hemodynamic classification according to 2022 ESC/ERS PH definition prior to mitral valve procedure vs. No pulmonary hypertension (mPAP ≤ 20 mmHg) at baseline was evaluated on High probability of pulmonary hypertension at follow-up based on echocardiographic criteria (peak TRV and indirect signs) (OR 10.66 for combined pre- and post-capillary PH vs no PH, 95% CI 95% CI 4.05–28.03, p=<0.001). Combined pre- and post-capillary pulmonary hypertension detected by RHC prior to mitral valve procedure was associated with a more than 10-fold higher risk (OR 10.66, 95% CI 4.05–28.03) of high pulmonary hypertension probability at 3-month follow-up compared to no baseline PH.