Reference : Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral ...
Scientific journals : Article
Human health sciences : Cardiovascular & respiratory systems
http://hdl.handle.net/2268/221320
Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation
English
Magne, J. [Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium]
Donal, E. [Cardiologie and CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France, LTSI, Université Rennes1, INSERM 1099, Rennes, France]
Mahjoub, H. [Quebec Heart and Lung Institute, Quebec, Canada]
Miltner, B. [Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium]
DULGHERU, Raluca Elena [Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie >]
Thebault, C. [Cardiologie and CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France, LTSI, Université Rennes1, INSERM 1099, Rennes, France]
Pierard, Luc mailto [Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques >]
Pibarot, P. [Quebec Heart and Lung Institute, Quebec, Canada]
Lancellotti, Patrizio mailto [Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie >]
2015
Heart
BMJ Publishing Group
101
5
391-396
Yes (verified by ORBi)
International
1355-6037
1468-201X
[en] Article ; Belgium ; Canada ; France ; Hypertension, Pulmonary ; Mitral Valve Insufficiency ; Postoperative Complications ; Stroke ; Age Factors ; Aged ; Asymptomatic Diseases ; Atrial Fibrillation ; Belgium ; Echocardiography, Stress ; Female ; Follow-Up Studies ; France ; Heart Atria ; Heart Failure ; Heart Ventricles ; Hospitalization ; Humans ; Hypertension, Pulmonary ; Male ; Middle Aged ; Mitral Valve Insufficiency ; Multivariate Analysis ; Postoperative Complications ; Prospective Studies ; Quebec ; Stroke
[en] Aims The management of asymptomatic patients with mitral regurgitation (MR) remains controversial. Exerciseinduced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid onset of symptoms. We hypothesised that ExPHT is a predictor of postoperative cardiovascular events in patients with primary MR. Methods and results One hundred and two patients with primary MR, no or mild symptoms (New York heart association (NYHA) ≤2), and no LV dysfunction/ dilatation, were prospectively recruited in 3 centres and underwent exercise-stress echocardiography. The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60 mm Hg. All patients were closely followed up and operated on when indication for surgery was reached. Postoperative events were de fined as the occurrence of atrial fibrillation (AF), stroke, cardiac-related hospitalisation or death. Among the 102 patients included, 59 developed ExPHT (58%). These patients were significantly older than those without ExPHT (p=0.01). During a mean postoperative follow-up of 50±23 months, 28 patients (26%) experienced a predefined cardiovascular event. Patients with ExPHT had significantly higher rate of postoperative events (39% vs 12%, p=0.005); the rate of events was still higher in these patients (32% vs 9%, p=0.013), even when excluding early postoperative AF (ie, within 48 h). Event-free survival was significantly lower in the ExPHT group (all events: 5-year: 60±8% vs 88±5%, p=0.007, events without early AF: 5-year: 67±7% vs 90±4%, p=0.02). Using Cox multivariable analysis, ExPHT remained independently associated with higher risk of postoperative events in all models (all p≤0.04). Conclusions ExPHT is associated with increased risk of adverse cardiac events following mitral valve surgery in patients with primary MR.
MOP # 102737, CIHR, Canadian Institutes of Health Research
http://hdl.handle.net/2268/221320
10.1136/heartjnl-2014-306296

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