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- Title
Echocardiographic predictors of exercise induced pulmonary hypertension in patients with asymptomatic moderate to severe mitral regurgitation and preserved left ventricular ejection fraction.
- Authors
Žvirblytė, Rūta; Montvilaitė, Aistė; Tamulėnaitė, Eglė; Saniukaitė, Agnė; Ereminienė, Eglė; Vaškelytė, Jolanta Justina
- Abstract
Background: The significant role of mitral regurgitation (MR) in development of pulmonary hypertension (PH) has been proved in previous studies. Experts suggest systolic pulmonary arterial pressure (SPAP) ⩾60 mmHg during exercise as a significant threshold of negative prognostic value in patients with MR. Purpose: The aim of this study was to evaluate the changes of SPAP and to ascertain the determinants of exercise induced pulmonary hypertension (EIPH) in patients with asymptomatic primary MR. Methods: We performed a prospective study that included 50 patients with asymptomatic primary moderate to severe MR with preserved left ventricular ejection fraction (LV EF ⩾60%) at rest. They were divided into two groups according to the presence (PH group; n = 13) or absence (non-PH group; n = 37) of EIPH. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed. Results: An increment of SPAP from rest to peak stress was higher in PH group (p < 0.001). Multivariate regression analysis showed that MR effective regurgitation orifice area (EROA; p = 0.008) and regurgitant volume (RVol; p = 0.006) contributed significantly to SPAP at rest. Higher increment of MR EROA during stress and worse parameters of LV diastolic function at rest (E, A, E/e') correlated significantly with higher SPAP during peak stress and they had a major role in predicting EIPH according to univariate logistic regression analysis. In ROC analysis SPAP >33.1 mmHg at rest could predict EIPH with 84.6% sensitivity and 87.1% specificity (95%CI 0.849–1.000; p < 0.001). Conclusions: Parameters of MR severity (EROA and RVol) were significant determinants of SPAP at rest, while the increment of MR EROA during stress and parameters of resting LV diastolic function were the best predictors of significant EIPH.
- Subjects
ECHOCARDIOGRAPHY; MITRAL valve insufficiency; STATISTICS; VENTRICULAR ejection fraction; CONFIDENCE intervals; SYSTOLIC blood pressure; PULMONARY hypertension; MULTIPLE regression analysis; PULMONARY artery; MANN Whitney U Test; SEVERITY of illness index; EXERCISE; DESCRIPTIVE statistics; LOGISTIC regression analysis; RECEIVER operating characteristic curves; SENSITIVITY &; specificity (Statistics); DATA analysis software; LONGITUDINAL method
- Publication
Perfusion, 2022, Vol 37, Issue 2, p188
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/0267659120987545