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To the Editor The study by Ratwatte et al 1 is a large national cohort retrospective assessment of mortality according to severity of pulmonary hypertension (pHTN) in patients with ≥moderate aortic regurgitation (AR); the authors should be commended for building such a large national database. While pHTN is associated with excess mortality in any clinical context,2 the relevant approach is to causally link the pHTN to the specific clinical context examined, in this case clinically significant AR, in order to infer its potential role in the management of AR. For this purpose, fundamental questions must be addressed: (1) Is this a representative cohort of patients with clinically significant AR? (2) Is the pHTN the result of advanced untreated AR? and (3) Do we have sufficient information on the consequences of AR and patient comorbidity burden to draw sound clinical …
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Contributors All authors have contributed to the intellectual content of the paper, grafting and revision of the paper and have approved the final submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.