title: Determinants of pulmonary hypertension development in moderate or severe aortic stenosis.
abstract: Pulmonary hypertension (PHT) is not uncommon in patients with aortic stenosis (AS) and portends a dismal prognosis. We attempted to determine the prevalence of PHT and to identify contributors to its development in patients with moderate or severe AS. A total of 189 patients were enrolled. Patients were divided into two groups according to the presence or absence of PHT, with a pulmonary artery systolic pressure cutoff value of 40 mmHg. Left ventricular (LV) systolic function was assessed by global longitudinal (LV-GLS), circumferential (LV-GCS) and radial (LV-GRS) strains on top of LV ejection fraction (LV-EF). The ratio of mitral E to septal mitral annular e' velocity (E/e') was calculated to estimate LV filling pressure. Fifty patients (26.5 %) had concomitant PHT. Patients with PHT had a higher prevalence of diabetes, a lower LV-EF, a higher E/e', a larger left atrial volume index, a smaller indexed aortic valve (AV) area, and a more reduced LV-GLS (all p < 0.05). However, LV-GRS and LV-GCS were similar in patients with or without PHT. On multivariate logistic regression analysis, LV-GLS and E/e' were independently associated with PHT, whereas LV-EF and indexed AV area were not. PHT complicating moderate or severe AS is commonly found and is independently associated with systolic and diastolic dysfunction assessed by Doppler and strain imaging, but not with LV-EF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Ahn
authors.forename: Sung-A
authors.initials: SA
authors.lastname: Chang
authors.forename: Hyung-Kwan
authors.initials: HK
authors.lastname: Kim
authors.forename: Seon Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.forename: Sung-Ji
authors.initials: SJ
authors.lastname: Park
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Goo-Yeong
authors.initials: GY
authors.lastname: Cho
authors.forename: Dae-Won
authors.initials: DW
authors.lastname: Sohn
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D062186:Arterial Pressure; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology*; D056910:Republic of Korea; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left