title: Frequency, determinants and outcome of pulmonary hypertension in patients with aortic valve stenosis.
abstract: BACKGROUND
  The frequency, causes and prognostic implications of pulmonary hypertension (PHT) in patients with severe aortic stenosis (AS) are not well defined. The objectives of this study were to determine the frequency of PHT [pulmonary artery systolic pressure (PASP) >50 mm Hg] in patients with severe AS, identify the factors associated with PHT and assess the relationship between PHT and clinical outcome.
  
  
  METHODS
  Patients with severe AS (aortic valve area ≤1.0 cm) and an echocardiographic estimate of PASP were identified by using the institutional echocardiography laboratory database. Patients with atrial fibrillation, mitral valve stenosis or a mitral prosthesis were excluded from analysis. The associations between clinical and echocardiographic parameters and PHT and the relationship between PHT and outcome were examined.
  
  
  RESULTS
  During the study period, 216 patients fulfilled the inclusion criteria (age: 75 ± 11 years; 43% men), and PHT was present in 64 patients (29.6%). By multivariate analysis, reduced left ventricular (LV) systolic function (LV ejection fraction ≤45% and lower stroke volume) and impaired LV diastolic function (mitral inflow E/A ratio ≥1.5 and greater left atrium size) were independent predictors of PHT. Mortality was higher among patients with PHT managed medically (adjusted hazard ratio, 1.87; 95% confidence interval, 1.06-3.30; P = 0.011), whereas patients with PHT who underwent aortic valve replacement had an excellent outcome.
  
  
  CONCLUSIONS
  PHT is common in patients with AS and is related to the severity of LV systolic and diastolic dysfunction. PHT is associated with poorer outcome in medically treated patients.
authors.affiliation: Echocardiography Laboratory and Heart Valves Clinic, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Diab
authors.initials: D
authors.lastname: Mutlak
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.forename: Shemy
authors.initials: S
authors.lastname: Carasso
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lessick
authors.forename: Shimon A
authors.initials: SA
authors.lastname: Reisner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Agmon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality*; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality*; D007557:Israel / Q000453:epidemiology; D008297:Male