Pulmonary hypertension predicts adverse cardiac events after restrictive mitral annuloplasty for severe functional mitral regurgitation

Kainuma, Satoshi; Taniguchi, Koichi; Toda, Köichi; Funatsu, Toshihiro; Kondoh, Haruhiko; Nishino, Masami; Daimon, Takashi; Sawa, Yoshiki

doi:10.1016/j.jtcvs.2010.11.031

Cited by 37 publications

(34 citation statements)

References 24 publications

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“…In patients with surgical MV repair, reduced LVEF and LV enlargement at both baseline and discharge were associated with elevated PCWP 17. In the present study, LVEF at both baseline and 12-month follow-up was significantly lower and LV end-diastolic volume and LV end-systolic volume at 12 months were significantly higher in patients with 12M-iASD than in patients without 12M-iASD.…”

Section: Discussionsupporting

confidence: 49%

Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip

Ikenaga

Hayashi

Nagaura

et al. 2018

Heart

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ObjectivesMitral valve (MV) clip procedure requires interatrial trans-septal puncture to access the left atrium (LA). Iatrogenic atrial septal defect (iASD) is not uncommon and may remain for a while. However, haemodynamic and echocardiographic determinants of persistent iASD are not well investigated. We sought to find haemodynamic and echocardiographic determinants of iASD after MV clip.MethodsA total of 131 patients with grades 3 to 4+ mitral regurgitation who underwent MitraClip and completed invasive haemodynamic measurement, baseline, 1 month and approximately 12 months of transthoracic echocardiography (TTE) follow-up were retrospectively reviewed.ResultsTTE at 1 month showed persistent iASD in 57% (1M-iASD). Mean LA pressure after clip was significantly higher in patients with 1M-iASD than patients without 1M-iASD (17±6 mm Hg vs 15±5 mm Hg, p=0.01). Among patients with 1M-iASD, 24 patients (35%) had persistent iASD at 12 months (12M-iASD). Mean LA pressure after clip was significantly higher in patients with 12M-iASD than patients without 12M-iASD (19±6 mm Hg vs 16±6 mm Hg, p=0.04). Patients with 12M-iASD did not significantly differ from patients without 12M-iASD in terms of right heart enlargement, estimated systolic pulmonary artery pressure, New York Heart Association functional class and brain natriuretic peptide at 12 months. Logistic regression analysis, however, showed that mean LA pressure after clip was significantly associated with persistent iASD at 12 months in patients with 1M-iASD even after adjustment for cardiac index after clip and the prevalence of mitral regurgitation ≥3+ at 12 months (OR 1.10 per 1 mm Hg, 95% CI 1.01 to 1.21, p=0.04).ConclusionsElevated LA pressure after MV clip was associated with persistent iASD.

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Section: Discussionsupporting

confidence: 49%

Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip

Ikenaga

Hayashi

Nagaura

et al. 2018

Heart

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“…PH due to valvular heart disease (VHD) was not always related to mortality risk,38 39 45 which is in contrast with PH in patients with heart failure. A simple explanation of this difference could be that the prevalence and severity of PH correlates with the severity and type of VHD.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the two studies included showed that surgery was safe and improved survival in patients with PH due to MS35 48 with PH regressing to normal levels over 6–12 months after successful Mitral Balloon Valvotomy (MBV) 35. In mitral regurgitation (MR), nearly all cohort studies on outcomes of severe PH reported increased mortality 38 39 40 46 49. The relevance of this finding is that PH can serve both as an indication for proceeding to surgical or catheter-based interventions, and also as an operative risk factor for mitral valve interventions 54.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospitalisations for heart failure and mortality in patients with pulmonary hypertension associated with left heart disease: a systematic review

et al. 2014

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ObjectivesLeft heart disease (LHD) is the main cause of pulmonary hypertension (PH), but little is known regarding the predictors of adverse outcome of PH associated with LHD (PH-LHD). We conducted a systematic review to investigate the predictors of hospitalisations for heart failure and mortality in patients with PH-LHD.DesignSystematic review.Data sourcesPubMed MEDLINE and SCOPUS from inception to August 2013 were searched, and citations identified via the ISI Web of Science.Study selectionStudies that reported on hospitalisation and/or mortality in patients with PH-LHD were included if the age of participants was greater than 18 years and PH was diagnosed using Doppler echocardiography and/or right heart catheterisation. Two reviewers independently selected studies, assessed their quality and extracted relevant data.ResultsIn all, 45 studies (38 from Europe and USA) were included among which 71.1% were of high quality. 39 studies were published between 2003 and 2013. The number of participants across studies ranged from 46 to 2385; the proportion of men from 21% to 91%; mean/median age from 63 to 82 years; and prevalence of PH from 7% to 83.3%. PH was consistently associated with increased mortality risk in all forms of LHD, except for aortic valve disease where findings were inconsistent. Six of the nine studies with data available on hospitalisations reported a significant adverse effect of PH on hospitalisation risk. Other predictors of adverse outcome were very broad and heterogeneous including right ventricular dysfunction, functional class, left ventricular function and presence of kidney disease.ConclusionsPH is almost invariably associated with increased mortality risk in patients with LHD. However, effects on hospitalisation risk are yet to be fully characterised; while available evidence on the adverse effects of PH have been derived essentially from Caucasians.

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“…PH is observed in approximately 40% of patients with LV systolic dysfunction (37% moderately elevated sPAP and 22% to 38% severe) (57,58). The vast majority of patients with PH and LV systolic dysfunction are symptomatic (69% of dyspnea, 29% of chest pain, 33% of pre-or syncope and 36% of fatigue) (58,59).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Pulmonary Hypertension in Aortic Stenosis and Mitral Regurgitation: Rest and Exercise Echocardiography Significance

Martinez

Bernard

Incarnato

et al. 2016

Progress in Cardiovascular Diseases

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Pulmonary hypertension predicts adverse cardiac events after restrictive mitral annuloplasty for severe functional mitral regurgitation

Abstract: Noninvasive assessment of preoperative PH has a prognostic value in patients undergoing RMA for severe functional mitral regurgitation secondary to advanced cardiomyopathy.

Cited by 37 publications

References 24 publications

Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip

Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip

Predictors of hospitalisations for heart failure and mortality in patients with pulmonary hypertension associated with left heart disease: a systematic review

Pulmonary Hypertension in Aortic Stenosis and Mitral Regurgitation: Rest and Exercise Echocardiography Significance

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