title: Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation.
abstract: OBJECTIVE
  The management of asymptomatic patients with mitral regurgitation (MR) remains controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid onset of symptoms. We hypothesised that ExPHT is a predictor of postoperative cardiovascular events in patients with primary MR.
  
  
  RESULTS
  One hundred and two patients with primary MR, no or mild symptoms (New York heart association (NYHA) ≤2), and no LV dysfunction/dilatation, were prospectively recruited in 3 centres and underwent exercise-stress echocardiography. The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60 mm Hg. All patients were closely followed up and operated on when indication for surgery was reached. Postoperative events were defined as the occurrence of atrial fibrillation (AF), stroke, cardiac-related hospitalisation or death. Among the 102 patients included, 59 developed ExPHT (58%). These patients were significantly older than those without ExPHT (p=0.01). During a mean postoperative follow-up of 50±23 months, 28 patients (26%) experienced a predefined cardiovascular event. Patients with ExPHT had significantly higher rate of postoperative events (39% vs 12%, p=0.005); the rate of events was still higher in these patients (32% vs 9%, p=0.013), even when excluding early postoperative AF (ie, within 48 h). Event-free survival was significantly lower in the ExPHT group (all events: 5-year: 60±8% vs 88±5%, p=0.007, events without early AF: 5-year: 67±7% vs 90±4%, p=0.02). Using Cox multivariable analysis, ExPHT remained independently associated with higher risk of postoperative events in all models (all p≤0.04).
  
  
  CONCLUSIONS
  ExPHT is associated with increased risk of adverse cardiac events following mitral valve surgery in patients with primary MR.
authors.affiliation: Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: Cardiologie & CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France LTSI, Université Rennes 1, INSERM 1099, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Haifa
authors.initials: H
authors.lastname: Mahjoub
authors.affiliation: Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Miltner
authors.affiliation: Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Raluca
authors.initials: R
authors.lastname: Dulgheru
authors.affiliation: Cardiologie & CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France LTSI, Université Rennes 1, INSERM 1099, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Thebault
authors.affiliation: Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Luc A
authors.initials: LA
authors.lastname: Pierard
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D000367:Age Factors; D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000453:epidemiology; D001530:Belgium / Q000453:epidemiology; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology
keywords: VALVULAR DISEASE