title: Pulmonary hypertension in rheumatic mitral stenosis revisited.
abstract: BACKGROUND
  In patients with mitral stenosis (MS), pulmonary hypertension (PH) is a significant contributor to the associated morbidity. We aimed to study factors associated with the presence of significant PH (sPH) and whether incorporating body surface area (BSA) in the mitral valve area (MVA) would improve the predictive value of the latter.
  
  
  METHODS
  The medical records of 558 patients with severe MS undergoing percutaneous balloon mitral commissurotomy were evaluated over a period of 8 years. Factors associated with the presence of significant PH (sPH) defined as mPAP ≥ 40 mm Hg were examined.
  
  
  RESULTS
  A total of 558 patients (423 women) were enrolled. Overall, 153 (27%) patients had sPH. Patients with sPH were similar to the rest of the subjects in terms of demographics, body habitus, blood group, and incidence of atrial fibrillation. Among echocardiographic findings, absolute MVA, indexed MVA, and mean transmitral valve gradient were associated with the presence of sPH. Transmitral valve gradient during right heart catheterization had the highest area under the curve for an association with sPH.
  
  
  CONCLUSIONS
  Age, gender, heart rhythm, and blood group were not associated with the presence of sPH in severe MS. The predictive value of the indexed MVA for the presence of sPH was not higher than that of absolute MVA.
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran.|Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Ghaffari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Ahmadi
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Tajlil
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran.
authors.forename: N
authors.initials: N
authors.lastname: Aslanabadi
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA. nnader@buffalo.edu.|Department of Anesthesiology, 77 Goodell Street, Suite # 550, 14203, Buffalo, NY, USA. nnader@buffalo.edu.
authors.forename: N D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D001830:Body Surface Area; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
keywords: Body surface area; Hemodynamics; Mitral valve stenosis; Pulmonary hypertension; Rheumatic heart disease