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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 MOURA FERREIRA, Sara CLAESSEN, Guido NIJST, Petra VANDERVOORT, Pieter BERTRAND, Philippe VERWERFT, Jan |
Issue Date: | 2023 | Publisher: | OXFORD UNIV PRESS | Source: | European Heart Journal-Cardiovascular Imaging, | Status: | Early view | 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. [GRAPHICS] . | Notes: | Bertrand, PB (corresponding author), Ziekenhuis Oost Limburg, Dept Cardiol, Synaps Pk 1, B-3600 Genk, Belgium.; Bertrand, PB (corresponding author), Hasselt Univ, Fac Med & Life Sci, Agoralaan, B-3590 Diepenbeek, Belgium. philippe.bertrand@zol.be |
Keywords: | primary mitral regurgitation;CPETecho;mPAP/CO slope;exercise pulmonary hypertension | Document URI: | http://hdl.handle.net/1942/42040 | ISSN: | 2047-2404 | e-ISSN: | 2047-2412 | DOI: | 10.1093/ehjci/jead313 | ISI #: | 001119598800001 | Rights: | The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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