Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.
Abstract
BACKGROUND AND AIM OF THE STUDY: Pulmonary hypertension frequently complicates mitral
stenosis, with a subset of these patients exhibiting pressures well in excess of their
mitral valve hemodynamics. The prevalence of this condition and its impact on clinical
outcome following percutaneous balloon mitral commissurotomy (PBMC) is unknown. METHODS:
The transpulmonary gradient (TPG) was measured in 317 patients undergoing PBMC; patients
were subsequently defined as having either an appropriate or excessive TPG (< or =15
mmHg or >15 mmHg, respectively). Twenty-two patients were excluded due to valvuloplasty-related
significant mitral regurgitation. The remaining 295 patients (250 females, 45 males;
mean age 52 +/- 13 years) were prospectively followed up, with each patient underwent
serial echocardiography. RESULTS: Among the patients, 214 (73%) had pulmonary hypertension
(pulmonary artery pressure >25 mmHg) and 55 (19%) also had an elevated TPG. Females
were almost fivefold more likely than males to have an elevated TPG (p = 0.003). Patients
with an elevated TPG had a worse mean NYHA functional class than those with a normal
TPG (3.0 +/- 0.5 versus 2.7 +/- 0.6, p = 0.01), while the mitral valve area (MVA)
was slightly smaller in patients with an elevated TPG (1.0 +/- 0.2 versus 1.1 +/-
0.2 cm2, p = 0.003). All patients demonstrated a significant increase in MVA after
commissurotomy (final MVA 1.7 +/- 0.6 cm2, p < 0.001 for elevated TPG; 1.8 +/- 0.4
cm2, p < 0.001 for normal TPG), and the NYHA class at six months was improved for
all patients (2.8 +/- 0.6 versus 1.6 +/- 0.7, p < 0.001). The improvements in NYHA
class, TPG and MVA were sustained at 36 months. CONCLUSION: Pulmonary hypertension
with elevated TPG occurs in patients with mitral stenosis, and is significantly more
common in females. Despite worse symptoms and higher right-sided pressures, PBMC is
equally successful in patients with a normal TPG, and provides sustained benefit for
up to 36 months after the procedure.
Type
Journal articleSubject
AdultAged
Blood Pressure
Cardiac Catheterization
Catheterization
Chi-Square Distribution
Echocardiography, Doppler
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Hypertension, Pulmonary
Male
Middle Aged
Mitral Valve Stenosis
North Carolina
Prospective Studies
Pulmonary Artery
Pulmonary Circulation
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
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Show full item recordScholars@Duke
Thomas Michael Bashore
Professor Emeritus of Medicine
The major areas of research involve mostly hemodynamic and imaging research: 1. Valvular
heart disease. 2. Adult congenital heart disease. 3. Pulmonary Hypertension. 4. Complex
cardiovascular problems. The Valvular Disease Program and Adult Congenital Program
are nationally recognized, and many trainees have gone on to academic careers at a
number of universities. Dr. Bashore is now or recently has been on the Editorial Boards
of Circulation, the American Jou
John Kevin Harrison
Professor of Medicine
Richard Andrew Krasuski
Professor of Medicine
Dr. Richard Krasuski is Director of the Adult Congenital Heart Center at Duke University
Medical Center, the Director of Hemodynamic Research, and the Medical Director of
the CTEPH Program. He is considered a thought leader in the fields of pulmonary hypertension
and congenital heart disease. His research focus is in epidemiologic and clinical
studies involving patients with pulmonary hypertension and patients with congenital
heart disease. He is involved in multiple multicenter studies thr
Andrew Wang
Professor of Medicine
Structural heart diseases, including valvular heart disease, hemodynamics, infective
endocarditis, and hypertrophic cardiomyopathy
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