Echocardiography predictors and prognostic value of pulmonary artery systolic pressure in chronic organic mitral regurgitation.

OBJECTIVE

To evaluate the predictors of pulmonary artery systolic pressure (PASP) in organic mitral regurgitation (MR) and its prognostic value after surgery.

DESIGN

Prospective observational study, conducted from 1998 to 2006.

SETTING

Echocardiography and cardiac surgery departments, University Hospital.

PATIENTS

Echocardiography was carried out in 256 patients (63+/-12 years, 170 male) with organic MR (degenerative aetiology: 91%) referred for surgery.

MAIN OUTCOME MEASURES

Echocardiography predictors of PASP. Postoperative end points were overall mortality and cardiovascular mortality.

RESULTS

Baseline PASP was 45+/-14 mmHg, ranging from 25 to 105 mmHg. PASP was > or = 50 mmHg in 82 patients (32%). Left atrial volume (p=0.003), mitral deceleration time (p<0.0001) and mitral medial E/E' (p<0.0001) were independent predictors of PASP, whereas left ventricular size and systolic function were not predictors. Mitral valve repair was performed in 194 patients (76%) and mitral valve replacement in 62 (24%). In a Cox model mitral valve repair (HR=0.41 (95% CI 0.20 to 0.85), p=0.016) and PASP (HR=1.43 (95% CI 1.09 to 1.88) per 10 mmHg increment, p=0.011) were independent predictors of overall mortality, even after adjustment for known predictors. PASP (HR=1.49 (95% CI 1.03 to 2.16) per 10 mmHg increment, p=0.033) was also an independent predictor of cardiac mortality. Eight-year survival after surgery was 58.6% and 86.6% in patients with baseline PASP > or = 50 mmHg or <50 mmHg, respectively (p<0.0001).

CONCLUSIONS

In organic MR, mitral deceleration time, mitral E/E' and left atrial volume correlate with PASP. Pulmonary artery systolic pressure > or = 50 mmHg is an independent predictor of overall and cardiovascular mortality after surgery in organic MR.