Exercise pulmonary hypertension by the mPAP/CO slope in primary mitral regurgitation.
Eur Heart J Cardiovasc Imaging
; 25(4): 530-538, 2024 Mar 27.
Article
in En
| MEDLINE
| ID: mdl-37976175
ABSTRACT
AIMS:
Exercise-induced pulmonary hypertension (PH), defined by a mean pulmonary arterial pressure over cardiac output (mPAP/CO) slope >3â mmHg/L/min, has important diagnostic and prognostic implications. The aim of this study is to investigate the value of the mPAP/CO slope in patients with more than moderate primary mitral regurgitation (MR) with preserved ejection fraction and no or discordant symptoms. METHODS ANDRESULTS:
A total of 128 consecutive patients were evaluated with exercise echocardiography and cardiopulmonary testing. Clinical outcome was defined as the composite of mitral valve intervention, new-onset atrial fibrillation, cardiovascular hospitalization, and all-cause mortality. The mean age was 63 years, 61% were male, and the mean LVEF was 66 ± 6%. The mPAP/CO slope correlated with peak VO2 (r = -0.52, P < 0.001), while the peak systolic pulmonary artery pressure (sPAP) did not (r = -0.06, P = 0.584). Forty-six per cent (n = 59) had peak exercise sPAP ≥60â mmHg, and 37% (n = 47) had mPAP/CO slope >3â mmHg/L/min. Event-free survival was 55% at 1 year and 46% at 2 years, with reduced survival in patients with mPAP/CO slope >3â mmHg/L/min (hazard ratio, 4.9; 95% confidence interval, 2.9-8.2; P < 0.001). In 53 cases (41%), mPAP/CO slope and peak sPAP were discordant patients with slope >3â mmHg/L/mmHg and sPAP <60â mmHg (n = 21) had worse outcome vs. peak sPAP ≥60â mmHg and normal slope (n = 32, log-rank P = 0.003). The mPAP/CO slope improved predictive models for outcome, incremental to resting and exercise sPAP, and peak VO2.CONCLUSION:
Exercise PH defined by the mPAP/CO slope >3â mmHg/L/min is associated with decreased exercise capacity and a higher risk of adverse events in significant primary MR and no or discordant symptoms. The slope provides a greater prognostic value than single sPAP measures and peak VO2.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hypertension, Pulmonary
/
Mitral Valve Insufficiency
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Eur Heart J Cardiovasc Imaging
Year:
2024
Document type:
Article
Affiliation country:
Belgium