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Impact of Pulmonary Hypertension on Outcomes in Patients With Mitral Annular Calcium and Associated Mitral Valve Dysfunction.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2022 Mar 15; Vol. 167, pp. 76-82. Date of Electronic Publication: 2022 Jan 03. - Publication Year :
- 2022
-
Abstract
- The prevalence of mitral annular calcium (MAC) is increasing in our aging population. However, data regarding prognostication in MAC-related mitral valve (MV) disease remain limited. This retrospective observational study aims to explore the prognostic impact of systolic pulmonary artery pressure (SPAP) in MAC-related MV dysfunction and define its determinants. We identified 4,384 patients (mean age 78 ± 11 years and 69% female) with MAC-related MV dysfunction (documented transmitral gradient ≥3 mm Hg) from a large institutional echocardiographic database between 2001 and 2019. In Cox regression analysis, higher SPAP strongly associated with all-cause mortality, independent of cardiovascular risk factors and indices of MV dysfunction (adjusted hazard ratio 1.22 per 10 mm Hg SPAP increase, 95% confidence interval 1.17 to 1.27). Patients with SPAP ≥50 mm Hg had significantly higher mortality compared with SPAP <50 mm Hg (log-rank p <0.001), a finding that was consistent across different transmitral gradient subgroups (≤5, 5 to 10, and ≥10 mm Hg). Independent determinants of SPAP included the mean transmitral gradient, mitral regurgitation severity, left ventricular ejection fraction, and ≥moderate aortic stenosis (adjusted p <0.05), and atrial fibrillation and left atrial dimension. The impact of concomitant mitral regurgitation on SPAP decreased at higher transmitral gradients and was no longer significant at gradients ≥10 mm Hg (p = 0.100). In conclusion, SPAP strongly associates with mortality in MAC, independent of cardiovascular risk factors and indices of MAC-related MV dysfunction. These findings suggest an incremental role for SPAP in the risk stratification and prognostication in this increasingly prevalent condition with expanding the scope of possible interventions.<br />Competing Interests: Disclosures The authors have no conflicts of interest to declare.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Calcium
Female
Humans
Male
Mitral Valve diagnostic imaging
Stroke Volume
Ventricular Function, Left
Heart Valve Diseases complications
Heart Valve Diseases epidemiology
Hypertension, Pulmonary
Mitral Valve Insufficiency complications
Mitral Valve Insufficiency epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 167
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 34991846
- Full Text :
- https://doi.org/10.1016/j.amjcard.2021.11.047