Article Text

PDF
Echocardiography predictors and prognostic value of pulmonary artery systolic pressure in chronic organic mitral regurgitation
  1. Thierry Le Tourneau,
  2. Marjorie Richardson,
  3. Francis Juthier,
  4. Thomas Modine,
  5. Georges Fayad,
  6. Anne-Sophie Polge,
  7. Pierre-Vladimir Ennezat,
  8. Christophe Bauters,
  9. André Vincentelli,
  10. Ghislaine Deklunder
  1. Inserm, UMR 915, Institut du Thorax, Nantes, and Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire, Lille, France
  1. Correspondence to Dr Thierry Le Tourneau, Laboratoire d'Explorations Fonctionnelles, Hotel Dieu, 1 Place Alexis Ricordeau, 44093 Nantes Cedex, France; thletourneau{at}yahoo.fr

Abstract

Objective To evaluate the predictors of pulmonary artery systolic pressure (PASP) in organic mitral regurgitation (MR) and its prognostic value after surgery.

Design Prospective observational study, conducted from 1998 to 2006.

Setting Echocardiography and cardiac surgery departments, University Hospital.

Patients Echocardiography was carried out in 256 patients (63±12 years, 170 male) with organic MR (degenerative aetiology: 91%) referred for surgery.

Main outcome measures Echocardiography predictors of PASP. Postoperative end points were overall mortality and cardiovascular mortality.

Results Baseline PASP was 45±14 mmHg, ranging from 25 to 105 mmHg. PASP was ≥50 mmHg in 82 patients (32%). Left atrial volume (p=0.003), mitral deceleration time (p<0.0001) and mitral medial E/E′ (p<0.0001) were independent predictors of PASP, whereas left ventricular size and systolic function were not predictors. Mitral valve repair was performed in 194 patients (76%) and mitral valve replacement in 62 (24%). In a Cox model mitral valve repair (HR=0.41 (95% CI 0.20 to 0.85), p=0.016) and PASP (HR=1.43 (95% CI 1.09 to 1.88) per 10 mmHg increment, p=0.011) were independent predictors of overall mortality, even after adjustment for known predictors. PASP (HR=1.49 (95% CI 1.03 to 2.16) per 10 mmHg increment, p=0.033) was also an independent predictor of cardiac mortality. Eight-year survival after surgery was 58.6% and 86.6% in patients with baseline PASP ≥50 mmHg or <50 mmHg, respectively (p<0.0001).

Conclusions In organic MR, mitral deceleration time, mitral E/E′ and left atrial volume correlate with PASP. Pulmonary artery systolic pressure ≥50 mmHg is an independent predictor of overall and cardiovascular mortality after surgery in organic MR.

  • Pulmonary artery pressure
  • mitral regurgitation
  • echocardiography
  • surgery
  • tissue Doppler
  • pulmonary arterial hypertension (PAH)
  • mitral valve prolapse

Statistics from Altmetric.com

Footnotes

  • Funding This work was supported by a grant from the Société Septentrionale d'Echocardiographie, Clinique de Bois Bernard, route de Neuvireuil, 62320 Bois-Bernard.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of Lille University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.