2024-03-28T14:13:49Zhttp://repisalud.isciii.es/oai/requestoai:repisalud.isciii.es:20.500.12105/121482023-10-06T11:49:03Zcom_20.500.12105_2137com_20.500.12105_2052com_20.500.12105_2051col_20.500.12105_2138
00925njm 22002777a 4500
dc
Bermejo, Javier
author
González-Mansilla, Ana
author
Mombiela, Teresa
author
Fernández, Ana I
author
Martínez-Legazpi, Pablo
author
Yotti-Alvarez, Raquel
author
García-Orta, Rocío
author
Sánchez-Fernández, Pedro L
author
Castaño, Mario
author
Segovia-Cubero, Javier
author
Escribano-Subias, Pilar
author
Alberto San Román, J
author
Borrás, Xavier
author
Alonso-Gómez, Angel
author
Botas, Javier
author
Crespo-Leiro, María G
author
Velasco, Sonia
author
Bayes-Genis, Antoni
author
López, Amador
author
Muñoz-Aguilera, Roberto
author
Jiménez-Navarro, Manuel
author
Gonzalez-Juanatey, Jose R
author
Evangelista, Arturo
author
Elizaga, Jaime
author
Martín-Moreiras, Javier
author
González-Santos, José M
author
Moreno-Escobar, Eduardo
author
Fernández-Avilés, Francisco
author
2021-01-19
Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.
J Am Heart Assoc . 2021 Jan 19;10(2):e019949.
http://hdl.handle.net/20.500.12105/12148
33399006
10.1161/JAHA.120.019949
2047-9980
Journal of the American Heart Association
Heart failure
Pulmonary hypertension
Valvular heart diseas
Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival.