The Anatolian Journal of Cardiology
Original Investigation

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

1.

Department of cardiology, Health Science University Istanbul Education and Research Hospital, İstanbul, Turkey

2.

Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital; İstanbul-Turkey

3.

Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey

4.

Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital; İstanbul-Turkey

5.

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, İstanbul, Türkiye

6.

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, İstanbul, Türkiye

Anatol J Cardiol 2021; 25: 437-446
DOI: 10.5152/AnatolJCardiol.2021.36114
Read: 189 Downloads: 96 Published: 01 June 2021

Objective: Increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important prognostic factors in patients with heart transplantation (HT). It is well known that severe mitral regurgitation increases pulmonary pressures. However, the European Society of Cardiology and the 6th World Symposium of pulmonary hypertension (PH) task force redefined severe functional mitral regurgitation (FMR) and PH, respectively. We aimed to investigate the effect of severe FMR on PAP and PVR based on these major redefinitions in patients with HT.

Methods: A total of 212 patients with HT were divided into 2 groups: those with severe FMR (n=70) and without severe FMR (n=142). Severe FMR was defined as effective orifice regurgitation area ≥20 mm2 and regurgitation volume ≥30 mL where the mitral valve was morphologically normal. A mean PAP of >20 mm Hg was accepted as PH. Patients with left ventricular ejection fraction ≤25% were included in the study.

Results: The systolic PAP, mean PAP, and PVR were higher in patients with severe FMR than in those without severe FMR [58.5 (48.0–70.2) versus 45.0 (36.0–64.0), p<0.001; 38.0 (30.2–46.6) versus 31.0 (23.0–39.5), p=0.004; 4.0 (2.3–6.8) versus 2.6 (1.2–4.3), p=0.001, respectively]. Univariate analysis revealed that the severe FMR is a risk factor for PVR ≥3 and 5 WU [odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1–3.6, p=0.009; and OR: 3.2, 95% CI: 1.5–6.7, p=0.002]. The multivariate regression analysis results revealed that presence of severe FMR is an independent risk factor for PVR ≥3 WU and presence of combined pre-post-capillary PH (OR: 2.23, 95% CI: 1.30–3.82, p=0.003 and OR: 2.30, 95% CI: 1.25–4.26, p=0.008).

Conclusion: Even in the updated definition of FMR with a lower threshold, severe FMR is associated with higher PVR, systolic PAP, and mean PAP and appears to have an unfavorable effect on pulmonary hemodynamics in patients with HT.

Cite this article as: Bayram Z, Doğan C, Acar RD, Efe S, Akbal ÖY, Yılmaz F, et al. How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates? Anatol J Cardiol 2021; 25: 437-46.

Files
ISSN 2149-2263 EISSN 2149-2271