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- Title
Exercise pulmonary hypertension by the mPAP/CO slope in primary mitral regurgitation.
- Authors
Dhont, Sebastiaan; Stassen, Jan; Herbots, Lieven; Hoedemakers, Sarah; Bekhuis, Youri; Jasaityte, Ruta; Stroobants, Sarah; Petit, Thibault; Bakelants, Elise; Falter, Maarten; Ferreira, Sara Moura; Claessen, Guido; Nijst, Petra; Vandervoort, Pieter M; Bertrand, Philippe B; Verwerft, Jan
- Abstract
Aims Exercise-induced pulmonary hypertension (PH), defined by a mean pulmonary arterial pressure over cardiac output (mPAP/CO) slope >3 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 and results 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 ≥60 mmHg, and 37% (n = 47) had mPAP/CO slope >3 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 >3 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 >3 mmHg/L/mmHg and sPAP <60 mmHg (n = 21) had worse outcome vs. peak sPAP ≥60 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 >3 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.
- Subjects
BELGIUM; PULMONARY hypertension diagnosis; EXERCISE; VENTRICULAR ejection fraction; PREDICTION models; RESEARCH funding; PULMONARY hypertension; PULMONARY artery; HOSPITAL care; SCIENTIFIC observation; CAUSES of death; DESCRIPTIVE statistics; CARDIAC output; MITRAL valve insufficiency; CARDIOPULMONARY system; LOG-rank test; LONGITUDINAL method; ATRIAL fibrillation; BLOOD pressure; EXERCISE tests; CONFIDENCE intervals; SYSTOLIC blood pressure; OXYGEN consumption; ECHOCARDIOGRAPHY; RELAXATION for health; BIOMARKERS
- Publication
European Heart Journal - Cardiovascular Imaging, 2024, Vol 25, Issue 4, p530
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jead313