Pulmonary Hypertension in Mitral Valve Disease-Rheumatic Mitral Stenosis versus Organic Mitral Regurgitation: The Doppler-Echocardiographic Study Revisited

Abstract

Background: Pulmonary hypertension (PH) is common in patients with mitral valve disease. Objective: To determine the factors associated with PH among patients with mitral valve disease, and the similarities and differences in the subgroups of mitral stenosis (MS) and mitral regurgitation (MR). Materials and Methods: Patients with isolated moderate to severe organic mitral valve disease were prospectively enrolled. PH was defined echocardiographically as pulmonary artery systolic pressure of more than 50 mmHg. Patients with MS who had mitral valve area of more than 1.5 cm² and patients with MR who had effective regurgitant orifice area of less than 20 mm² were excluded. Results: Three hundred eighteen patients with a mean age of 54.3±15.5 years including 57.6% female and 66.7% MR were included in this study. PH was present in 119 patients (37.4%), including 48.1% in MS and 31.8% in MR. Severe mitral valve disease was reported in 245 patients (77.0%). Left atrial (LA) diameter and pulmonary artery pressure were significantly higher in patients with MS. Dyspnea, LA volume index, significant tricuspid and pulmonary regurgitation, severe mitral valve disease, and the presence of MS were independently associated with PH. Among patients with MS, LA volume index and severe disease were independently associated with PH. Significant tricuspid and pulmonary regurgitation, LA volume index and severe disease were independently associated with PH in patients with MR. Conclusion: PH is common in patients with mitral valve disease. LA volume index and severe disease were, in common, independently associated with PH in patients with mitral valve disease and in the subgroups of MS and MR. Keywords: Mitral regurgitation; Mitral stenosis; Pulmonary hypertension; Rheumatic heart disease