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oai:recercat.cat:11351/60562025-10-24T10:34:10Zcom_2072_378070com_2072_378040col_2072_378092

Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long‐Term Survival Bermejo, Javier González-Mansilla, Ana Mombiela, Teresa Fernández, Ana I. Martínez-Legazpi, Pablo Yotti, Raquel Evangelista Masip, Artur Institut Català de la Salut [Bermejo J, González-Mansilla A, Mombiela T, Fernández AI, Martínez-Legazpi P] Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain. [Yotti R] Instituto de Salud Carlos III Madrid Spain. [Evangelista A] Vall d'Hebron Hospital Universitari, Barcelona, Spain. CIBERCV Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Cor - Vàlvules - Malalties Hipertensió pulmonar - Factors de risc DISEASES::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases DISEASES::Respiratory Tract Diseases::Lung Diseases::Hypertension, Pulmonary ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::enfermedades de las válvulas cardíacas ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::hipertensión pulmonar TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::estadística como asunto::probabilidad::riesgo::factores de riesgo Insuficiència cardíaca; Hipertensió pulmonar; Malaltia valvular cardíaca Insuficiencia cardiaca; Hipertensión pulmonar; Enfermedad valvular cardíaca Heart failure; Pulmonary hypertension; Valvular heart disease 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. This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain, the European Union–European Regional Development Fund (EC07/90772 and PI19/00649), and the Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). 2021-06-11T12:32:02Z 2021-06-11T12:32:02Z 2021-01-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Bermejo J, González‐Mansilla A, Mombiela T, Fernández AI, Martínez‐Legazpi P, Yotti R, et al. Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long‐Term Survival. J Am Heart Assoc. 2021 Jan 19;10(2):e019949. 2047-9980 https://hdl.handle.net/11351/6056 10.1161/JAHA.120.019949 33399006 000610049900028 http://hdl.handle.net/11351/6056 eng Journal of the American Heart Association;10(2) https://www.ahajournals.org/doi/10.1161/JAHA.120.019949 info:eu-repo/grantAgreement/ES/PE2017-2020/PI19%2F00649 Attribution-NonCommercial 4.0 International http://creativecommons.org/licenses/by-nc/4.0/ info:eu-repo/semantics/openAccess application/pdf Wiley Scientia