Pulmonary hypertension in rheumatic mitral stenosis revisited.

Abstract

In patients with mitral stenosis (MS), pulmonary hypertension (PH) is asignificant 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. The medical records of 558 patients with severe MS undergoing percutaneous balloon mitral commissurotomy were evaluated over aperiod of 8years. Factors associated with the presence of significant PH (sPH) defined as mPAP≥ 40 mmHg were examined. Atotal 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. 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.