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Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation.

Publication ,  Journal Article
Parker, MW; Mittleman, MA; Waksmonski, CA; Sanders, G; Riley, MF; Douglas, PS; Manning, WJ
Published in: Am J Med
November 2010

BACKGROUND: Outcomes data in patients with aortic regurgitation or mitral regurgitation have been limited to small series with generally <10 years of follow-up. The quantitative impact of pulmonary artery hypertension has not been well described. The purpose of this study was to describe the 15-year mortality of aortic regurgitation and mitral regurgitation. METHODS: Our institution's electronic echocardiography database was queried to identify those patients examined in 1992 and reported to have at least mild aortic regurgitation or mitral regurgitation. Patients were classified by semi-quantitative degree of regurgitation. Pulmonary artery systolic pressure was categorized as normal, borderline, mild, or moderate or greater hypertension (pulmonary artery systolic pressure >40 mm Hg). Age-stratified Cox proportional hazards models compared survival among groups and adjusted for sex, depressed left ventricular ejection fraction, and pulmonary artery systolic pressure. Mortality data were obtained from the 2008 Social Security Death Index. RESULTS: Of 4984 echocardiograms performed in 4050 patients, 1156 patients (28%; aged 72±14 years) had at least mild aortic regurgitation and 1971 patients (49%; aged 69±16 years) had at least mild mitral regurgitation. Overall 15-year mortality in patients with aortic regurgitation was 74% and similar for all grades of aortic regurgitation. Overall 15-year mortality in patients with mitral regurgitation was 71% and got progressively worse with increasing severity grade of mitral regurgitation (63% for mild to 81% for at least moderate-to-severe). For both aortic and mitral regurgitation, moderate or greater pulmonary artery systolic hypertension was associated with increased mortality (in patients with aortic regurgitation, hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.58-2.41, and in mitral regurgitation patients, HR, 1.48; 95% CI, 1.26-1.75). CONCLUSION: Long-term (15-year) survival of patients with aortic regurgitation is poor and is independent of regurgitation severity. In contrast, long-term survival of patients with mitral regurgitation correlates with regurgitation severity. For both groups, moderate or greater pulmonary artery systolic hypertension identified those at highest risk.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

November 2010

Volume

123

Issue

11

Start / End Page

1043 / 1048

Location

United States

Related Subject Headings

  • Stroke Volume
  • Sex Factors
  • Proportional Hazards Models
  • Mitral Valve Insufficiency
  • Male
  • Kaplan-Meier Estimate
  • Hypertension, Pulmonary
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Parker, M. W., Mittleman, M. A., Waksmonski, C. A., Sanders, G., Riley, M. F., Douglas, P. S., & Manning, W. J. (2010). Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation. Am J Med, 123(11), 1043–1048. https://doi.org/10.1016/j.amjmed.2010.06.018
Parker, Matthew W., Murray A. Mittleman, Carol A. Waksmonski, Greg Sanders, Marilyn F. Riley, Pamela S. Douglas, and Warren J. Manning. “Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation.Am J Med 123, no. 11 (November 2010): 1043–48. https://doi.org/10.1016/j.amjmed.2010.06.018.
Parker MW, Mittleman MA, Waksmonski CA, Sanders G, Riley MF, Douglas PS, et al. Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation. Am J Med. 2010 Nov;123(11):1043–8.
Parker, Matthew W., et al. “Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation.Am J Med, vol. 123, no. 11, Nov. 2010, pp. 1043–48. Pubmed, doi:10.1016/j.amjmed.2010.06.018.
Parker MW, Mittleman MA, Waksmonski CA, Sanders G, Riley MF, Douglas PS, Manning WJ. Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation. Am J Med. 2010 Nov;123(11):1043–1048.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

November 2010

Volume

123

Issue

11

Start / End Page

1043 / 1048

Location

United States

Related Subject Headings

  • Stroke Volume
  • Sex Factors
  • Proportional Hazards Models
  • Mitral Valve Insufficiency
  • Male
  • Kaplan-Meier Estimate
  • Hypertension, Pulmonary
  • Humans
  • General & Internal Medicine
  • Female