1. Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival
- Author
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Bermejo, Javier, González-Mansilla, Ana, Mombiela, Teresa, Fernández, Ana I., Martínez-Legazpi, Pablo, Yotti, Raquel, García-Orta, Rocío, Sánchez-Fernández, Pedro L., Castaño, Mario, Segovia-Cubero, Javier, Escribano-Subias, Pilar, San Román, J.Alberto, Borràs Pino, Xavier, Alonso-Gómez, Ángel María, Botas, Javier, Crespo-Leiro, Maria Generosa, Velasco, Sonia, Bayés-Genís, Antoni, López, Amador, Muñoz-Aguilera, Roberto, Jiménez-Navarro, Manuel, González-Juanatey, José R., Evangelista, Arturo, Elízaga, Jaime, Martín-Moreiras, Javier, González-Santos, José M., Moreno-Escobar, Eduardo, Fernández Avilés, F., García-Robles, José A., Pérez-David, Esther, Pérez Del Villar, Candelas, Sanz, Ricardo, Gutierrez-Ibanes, Enrique, Vázquez, María E., Mur, Ana, Benito, Yolanda, Barrio, Alicia, Vázquez, Alexandra, Uribe, Inés, González, Mercedes, Arribas, Antonio, Clemente Lorenzo, M. Milagros, Nieto, Alejandro Diego, Pérez De Prado, Armando, Alonso, David, Gómez-Bueno, Manuel, Sayago Silva, Inés, Cavero, Miguel Ángel, Domínguez, Laura, Tello De Meneses, Rocío, Ruíz Cano, María José, Jiménez López-Guarch, Carmen, Mota, Pedro, Amorós Galitó, Carmen, Belló Mora, M. Concepción, Mesa Rubio, Dolores, Campuzano, Raquel, Marzoa, Raquel, Cuenca, José, Muñoz, Roberto, Suberviola, Verónica, Beltrán Herrera, Cristina, Mora, Laura, Sarrión, M. Mar, Vaqueriza, David, Ferrer, Elena, Cid-Álvarez, Belén, Martínez Monzonís, Amparo, Arizón De Prado, José M., Santisteban, Marta, García-Dorado, David, De Teresa, Eduardo, Carrasco-Chinchilla, Fernando, Alonso, Joaquín, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (España), European Regional Development Fund (ERDF/FEDER), Centro de Investigación Biomedica en Red - CIBER, Institut Català de la Salut, [Bermejo J, González-Mansilla A, Mombiela T, Fernández AI, Martínez-Legazpi P] Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain. [Yotti R] Instituto de Salud Carlos III Madrid Spain. [Evangelista A] Vall d'Hebron Hospital Universitari, Barcelona, Spain. CIBERCV Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Male ,Heart Valve Diseases ,Hemodynamics ,Long Term Adverse Effects ,heart failure ,030204 cardiovascular system & hematology ,Valvular heart diseas ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Hipertensió pulmonar - Factors de risc ,pulmonary hypertension ,030212 general & internal medicine ,Original Research ,Heart Valve Prosthesis Implantation ,valvular heart disease ,Organ Size ,Middle Aged ,Heart Valves ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,enfermedades respiratorias::enfermedades pulmonares::hipertensión pulmonar [ENFERMEDADES] ,Hypertension, Pulmonary ,Heart failure ,enfermedades cardiovasculares::enfermedades cardíacas::enfermedades de las válvulas cardíacas [ENFERMEDADES] ,técnicas de investigación::métodos epidemiológicos::estadística como asunto::probabilidad::riesgo::factores de riesgo [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Sildenafil Citrate ,Pulmonary hypertension ,03 medical and health sciences ,Respiratory Tract Diseases::Lung Diseases::Hypertension, Pulmonary [DISEASES] ,Double-Blind Method ,Internal medicine ,Long term survival ,medicine ,Diabetes Mellitus ,Humans ,Pulmonary Wedge Pressure ,business.industry ,Persistent pulmonary hypertension ,Cor - Vàlvules - Malalties ,Phosphodiesterase 5 Inhibitors ,medicine.disease ,Valvular heart disease ,Valvular Heart Disease ,Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases [DISEASES] ,Vascular Resistance ,Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,business - Abstract
Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00862043.
- Published
- 2021