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Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.

dc.contributor.author Bashore, TM
dc.contributor.author Harrison, JK
dc.contributor.author Hart, Stephen A
dc.contributor.author Kisslo, K
dc.contributor.author Krasuski, Richard Andrew
dc.contributor.author Wang, Andrew
dc.coverage.spatial England
dc.date.accessioned 2015-12-03T17:54:47Z
dc.date.issued 2010-11
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/21214093
dc.identifier.issn 0966-8519
dc.identifier.uri https://hdl.handle.net/10161/11035
dc.description.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.
dc.language eng
dc.relation.ispartof J Heart Valve Dis
dc.subject Adult
dc.subject Aged
dc.subject Blood Pressure
dc.subject Cardiac Catheterization
dc.subject Catheterization
dc.subject Chi-Square Distribution
dc.subject Echocardiography, Doppler
dc.subject Echocardiography, Transesophageal
dc.subject Female
dc.subject Follow-Up Studies
dc.subject Humans
dc.subject Hypertension, Pulmonary
dc.subject Male
dc.subject Middle Aged
dc.subject Mitral Valve Stenosis
dc.subject North Carolina
dc.subject Prospective Studies
dc.subject Pulmonary Artery
dc.subject Pulmonary Circulation
dc.subject Risk Assessment
dc.subject Risk Factors
dc.subject Sex Factors
dc.subject Time Factors
dc.subject Treatment Outcome
dc.title Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/21214093
pubs.begin-page 708
pubs.end-page 715
pubs.issue 6
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 19


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