title: Effect of Pulmonary Vascular Pressures on Long-Term Outcome in Patients With Primary Mitral Regurgitation.
abstract: Primary mitral regurgitation (MR) is a growing health problem due to the aging population.
  
  
  
  The purpose of this study was to assess the impact of baseline pulmonary hypertension on long-term outcomes in patients with significant primary MR and preserved left ventricular ejection fraction (LVEF).
  
  
  
  We studied 1,318 patients with ≥3+ primary MR and LVEF ≥60% using echocardiography at rest; they were evaluated at our center from 2005 to 2008. Baseline clinical and echocardiography data were recorded, and the Society of Thoracic Surgeons (STS) score was calculated. The primary outcome was death.
  
  
  
  Mean STS score was 3.98 ± 1%; 54% of patients were in New York Heart Association (NYHA) functional class I and 31% were in NYHA functional class II; and 18% had atrial fibrillation (AF). Mean LVEF, mitral effective regurgitant orifice, indexed LV end-systolic diameter (LVESD), and right ventricular systolic pressure (RVSP) were 62 ± 2%, 0.56 ± 0.30 cm(2), 1.6 ± 0.3 cm/m(2), and 37 ± 14 mm Hg, respectively. At 7.1 ± 2.0 years, 86% had mitral valve (MV) surgery. Death occurred in 130 (10%) patients. On Cox multivariable analysis, baseline RVSP, together with age, baseline NYHA functional class, pre-operative AF, coronary artery disease, and indexed LVESD were associated with a higher rate of longer term mortality (all p < 0.01), whereas MV surgery (as a time-dependent covariate) was associated with improved survival (p < 0.001). Addition of RVSP to the STS score significantly reclassified the risk for longer term mortality (integrated discrimination index: 0.07; p < 0.001); 77% patients who died had RVSP ≥35 mm Hg.
  
  
  
  In patients with significant primary MR and preserved LVEF, baseline RVSP is independently associated with long-term survival. Impact of RVSP is progressive and not confined to those with the highest baseline values.
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amgad
authors.initials: A
authors.lastname: Mentias
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Krishna
authors.initials: K
authors.lastname: Patel
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Harsh
authors.initials: H
authors.lastname: Patel
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: L Leonardo
authors.initials: LL
authors.lastname: Rodriguez
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.affiliation: Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: desaim2@ccf.org.
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: preserved ejection fraction; pulmonary hypertension; right ventricular systolic pressure; risk stratification