Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long‐Term Survival

Author:

Bermejo Javier1ORCID,González‐Mansilla Ana1ORCID,Mombiela Teresa1,Fernández Ana I.1,Martínez‐Legazpi Pablo1ORCID,Yotti Raquel2ORCID,García‐Orta Rocío3,Sánchez‐Fernández Pedro L.4ORCID,Castaño Mario5,Segovia‐Cubero Javier6,Escribano‐Subias Pilar7,Alberto San Román J.8,Borrás Xavier9,Alonso‐Gómez Angel10ORCID,Botas Javier11ORCID,Crespo‐Leiro María G.12ORCID,Velasco Sonia13,Bayés‐Genís Antoni14ORCID,López Amador15,Muñoz‐Aguilera Roberto16,Jiménez‐Navarro Manuel17ORCID,González‐Juanatey José R.18,Evangelista Arturo19,Elízaga Jaime1,Martín‐Moreiras Javier4,González‐Santos José M.4ORCID,Moreno‐Escobar Eduardo20,Fernández‐Avilés Francisco1ORCID,

Affiliation:

1. Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain

2. Instituto de Salud Carlos III Madrid Spain

3. Hospital Virgen de las Nieves Granada Spain

4. Hospital Clínico Universitario de Salamanca, and CIBERCV Salamanca Salamanca Spain

5. Hospital Universitario de León León Spain

6. Hospital Puerta de Hierro Majadahonda and CIBERCV Majadahonda Spain

7. Hospital 12 de Octubre and CIBERCV Madrid Spain

8. Hospital Clínico de Valladolid and CIBERCV Valladolid Spain

9. Hospital Santa Creu i San Pau and CIBERCV Barcelona Spain

10. Hospital Universitario de Araba‐Txagorritxu Vitoria Spain

11. Hospital Universitario Fundación Alcorcón Alcorcón Spain

12. Complejo Hospitalario Universitario de A Coruña and CIBERCV A Coruña Spain

13. Hospital de Galdakao‐Usansolo Usansolo Spain

14. Hospital Universitari Germans Trias i Pujol and CIBERCV Badalona Spain

15. Hospital Universitario Reina Sofía Córdoba Spain

16. Hospital Infanta Leonor Madrid Spain

17. Hospital Virgen de la Victoria and CIBERCV Málaga Spain

18. Hospital Clínico de Santiago de Compostela and CIBERCV Santiago de Compostela Spain

19. Hospital Universitario de la Vall d’Hebron and CIBERCV Barcelona Spain

20. Hospital Universitario San Cecilio Granada Spain

Abstract

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00862043.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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