Echocardiography Predictors and Prognostic Value of Pulmonary Artery Systolic Pressure in Chronic Organic Mitral Regurgitation

Objective: To evaluate the predictors of pulmonary artery systolic pressure (PASP) in organic mitral regurgitation (MR) and its prognostic value after surgery.

Design: Prospective observational study, conducted from 1998 to 2006.

Setting: Echocardiography and cardiac surgery departments, University Hospital.

Patients: Echocardiography was carried out in 256 patients (63+/-12 years, 170 male) with organic MR (degenerative aetiology: 91%) referred for surgery.

Main Outcome Measures: Echocardiography predictors of PASP. Postoperative end points were overall mortality and cardiovascular mortality.

Results: Baseline PASP was 45+/-14 mmHg, ranging from 25 to 105 mmHg. PASP was > or = 50 mmHg in 82 patients (32%). Left atrial volume (p=0.003), mitral deceleration time (p<0.0001) and mitral medial E/E' (p<0.0001) were independent predictors of PASP, whereas left ventricular size and systolic function were not predictors. Mitral valve repair was performed in 194 patients (76%) and mitral valve replacement in 62 (24%). In a Cox model mitral valve repair (HR=0.41 (95% CI 0.20 to 0.85), p=0.016) and PASP (HR=1.43 (95% CI 1.09 to 1.88) per 10 mmHg increment, p=0.011) were independent predictors of overall mortality, even after adjustment for known predictors. PASP (HR=1.49 (95% CI 1.03 to 2.16) per 10 mmHg increment, p=0.033) was also an independent predictor of cardiac mortality. Eight-year survival after surgery was 58.6% and 86.6% in patients with baseline PASP > or = 50 mmHg or <50 mmHg, respectively (p<0.0001).

Conclusions: In organic MR, mitral deceleration time, mitral E/E' and left atrial volume correlate with PASP. Pulmonary artery systolic pressure > or = 50 mmHg is an independent predictor of overall and cardiovascular mortality after surgery in organic MR.