June 1, 2023Open Access
Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes
Key Result
In adults with moderate or greater mitral regurgitation, pulmonary hypertension (eRVSP >34 mm Hg) was associated with increased long-term mortality (HR 1.27; 95% CI 1.00-1.36).
Study Design
Type
Cohort (n=9,683)
Multicenter
Yes
Structured PICO
Does the severity of pulmonary hypertension influence long-term mortality in adults with moderate or greater mitral regurgitation and preserved LVEF?
P
Population
9,683 adults with moderate or greater mitral regurgitation and LVEF >50%, followed for a median of 3.2 years to assess the prognostic impact of pulmonary hypertension.
E
Exposure
Pulmonary hypertension (categorized by estimated right ventricular systolic pressure [eRVSP] severity)
C
Comparator
No pulmonary hypertension
O
Outcome
Long-term mortalityhard clinical
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.
Main Result
Hazard Ratio: 1.27 (95% CI 1–1.36)
p-value: p=<0.0001
Abstract
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 (p34.00 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.