Key result
Severe pulmonary hypertension linked to ~2.9-fold higher mortality in moderate or greater mitral regurgitation.
Why the study?
Pulmonary hypertension commonly coexists with significant mitral regurgitation, but its prevalence and prognostic importance have not been well characterised.
Does the severity of pulmonary hypertension influence long-term mortality in adults with moderate or greater mitral regurgitation and preserved LVEF?
Cohort (n=9,683)
Yes
Does the severity of pulmonary hypertension influence long-term mortality in adults with moderate or greater mitral regurgitation and preserved LVEF?
In patients with moderate or greater mitral regurgitation and preserved LVEF, mortality risk progressively increases as pulmonary hypertension becomes more severe, starting from an eRVSP of 34 mm Hg.
May inform prognostic counseling in mitral regurgitation with preserved LVEF; extends observational data but leaves open therapeutic implications.
OBJECTIVE: Pulmonary hypertension (PHT) commonly coexists with significant mitral regurgitation (MR), but its prevalence and prognostic importance have not been well characterised. In a large cohort of adults with moderate or greater MR, we aimed to describe the prevalence and severity of PHT and assess its influence on outcomes. METHODS: In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000 to 2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction >50% and with moderate or greater MR were included (n=9683). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes was evaluated (median follow-up of 3.2 years, IQR 1.3-6.2 years). RESULTS: Subjects were aged 76±12 years, and 62.6% (6038) were women. Overall, 959 (9.9%) had no PHT, and 2952 (30.5%), 3167 (32.7%), 1588 (16.4%) and 1017 (10.5%) patients had borderline, mild, moderate and severe PHT, respectively. A 'typical left heart disease' phenotype was identified with worsening PHT, showing rising E:e', right and left atrial sizes increasing progressively, from no PHT to severe PHT (p<0.0001, for all). With increasing PHT severity, 1- and 5-year actuarial mortality increased from 8.5% and 33.0% to 39.7% and 79.8%, respectively (p<0.0001). Similarly, adjusted survival analysis showed the risk of long-term mortality progressively increased with higher eRVSP levels (adjusted HR 1.20-2.86, borderline to severe PHT, p<0.0001 for all). A mortality inflection was apparent at an eRVSP level >34.00 mm Hg (HR 1.27, CI 1.00-1.36). CONCLUSIONS: In this large study, we report on the importance of PHT in patients with MR. Mortality increases as PHT becomes more severe from an eRVSP of 34 mm Hg onwards.
No takes yet. Share an insight, caveat, or question.
Ratwatte et al. (2023) conducted a cohort in Mitral Regurgitation (n=9,683). Severe pulmonary hypertension (eRVSP >60 mm Hg) vs. Normal eRVSP (<30 mm Hg) was evaluated on All-cause mortality (HR 2.86, 95% CI 2.48-3.31, p=<0.0001). In adults with moderate or greater mitral regurgitation, severe pulmonary hypertension significantly increased the risk of all-cause mortality compared to those with normal pulmonary pressures (HR 2.86).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: