Background

Mitral regurgitation (MR) and elevated pulmonary artery pressure are common findings in patients with aortic valve stenosis (AS). The pathophysiologic role of quantitatively defined MR as a determinant of pulmonary hypertension (PH) is incompletely characterized across the whole spectrum of AS degrees. The purpose of the study was to investigate whether the quantification of MR reveals a link to PH in patients with AS.

Methods

Consecutive patients undergoing comprehensive echocardiography and presenting peak aortic velocity ≥ 2.5 m/sec were prospectively enrolled. Effective regurgitant orifice area (ERO) and regurgitant volume were obtained using the proximal isovelocity surface area method. Systolic pulmonary artery pressure was calculated by adding right atrial pressure to the tricuspid regurgitation pressure gradient.

Results

A total of 642 patients were enrolled between 2008 and 2013 (mean age, 79 ± 11 years; mean ejection fraction, 62 ± 10%; mean aortic valve area, 1.09 ± 0.39 cm²); MR was present in 187 (29%). Of note, 154 of 187 patients (82%) showed ERO < 0.20 cm². ERO and regurgitant volume had the most significant associations with systolic pulmonary artery pressure (R² = 0.30 and R² = 0.35, respectively, P < .0001). This relationship persisted after multivariate adjustment and in the subgroups of patients with severe AS or reduced ejection fraction (P < .0001). For each 0.10-cm² increase, the odds ratio for PH was 3.56 (95% CI, 2.65–4.86; P < .0001).

Conclusions

In patients with MR and a wide range of AS severity, ERO is independently associated with PH. Also, the role of MR quantification appears stronger than other continuous variables commonly associated with left ventricular diastolic dysfunction, such as E/e′ ratio and left atrial volume.

中文翻译：

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二尖瓣有效反流孔面积可预测主动脉瓣狭窄患者的肺动脉压水平

背景

二尖瓣反流（MR）和肺动脉压升高是主动脉瓣狭窄（AS）患者的常见发现。定量定义的MR作为肺动脉高压（PH）的决定因素的病理生理作用在整个AS度范围内均未完全表征。这项研究的目的是调查MR的定量是否揭示了AS患者的PH值。

方法

连续接受了综合超声心动图检查并且主动脉峰值速度≥2.5 m / sec的患者。使用近端等速表面积法获得有效的返流孔面积（ERO）和返流体积。通过在三尖瓣关闭不全压力梯度上加上右心房压力来计算收缩期肺动脉压力。

结果

在2008年至2013年间共纳入642例患者（平均年龄为79±11岁；平均射血分数为62±10％；主动脉瓣平均面积为1.09±0.39 cm ²）；MR出现在187位（占29％）。值得注意的是，在187位患者中，有154位（82％）的ERO <0.20 cm ²。ERO和反流体积与收缩期肺动脉压之间的关系最为显着（分别为R ²  = 0.30和R ²  = 0.35，P  <.0001）。在多变量调整后以及在重型AS或射血分数降低的患者亚组中，这种关系仍然存在（P  <.0001）。每增加0.10-cm ²，PH的优势比为3.56（95％CI，2.65-4.86；P  <.0001）。

结论

在MR和AS严重程度广泛的患者中，ERO与PH独立相关。同样，MR量化的作用似乎比通常与左心室舒张功能障碍相关的其他连续变量，例如E / e'比和左心房容积更强。