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Valvular & structural heart diseaseCohort study

Reappraisal of the Concept and Implications of Pulmonary Hypertension in Degenerative Mitral Regurgitation

JACC Cardiovasc ImagingPublished

  • Registry-based cohort study
  • multicentre
  • prospective quantification at diagnosis
  • consecutive patients
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Authors' conclusion

This large international registry, with prospectively quantified DMR and SPAP, demonstrates a Doppler-defined PHTN impact on mortality, independent of DMR severity.

Study context

Population
Consecutive patients with isolated ≥ moderate-to-severe degenerative mitral regurgitation
Participants
3,712 patients
Exposure
Severe and moderate pulmonary hypertension vs no pulmonary hypertension in degenerative mitral regurgitation (DMR)
  • Severe pulmonary hypertension (sPHTN)n = 916
  • Moderate pulmonary hypertension (mPHTN)n = 1,128
  • no-PHTNn = 1,668reference
Outcome
Mortality (under medical management)

Main finding

As reported in the abstract

Mortality
independent of ERO and baseline characteristics
Each group vs no-PHTNAdjusted hazard ratio (95% CI)P value
sPHTN
1.65(1.24–2.20)
P ≤ 0.005
mPHTN
1.44(1.11–1.85)
P ≤ 0.005

Observational data: associations, not effects.

Further findings

Incremental prognostic value (nested models)

Incremental prognostic value of mPHTN and sPHTN
P < 0.0001

Postoperative mortality

Excess mortality abolished in mPHTN
P ≥ 0.30
Excess mortality only abated in sPHTN

Original publication

Reappraisal of the Concept and Implications of Pulmonary Hypertension in Degenerative Mitral Regurgitation. JACC Cardiovasc Imaging. Published 26 June 2024. doi:10.1016/j.jcmg.2024.05.006
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Summarised from the published abstract; every number is checked against it