Clinical and morphological profiles in different hemodynamic types of pulmonary hypertension in patients with mitral valve disease and predictors of persistent pulmonary hypertension post-surgery
S Barbarash, I Lyapina, T Martynyuk, L Bogdanov, A Kutikhin, Yu Argunova, E Dren, O BarbarashAbstract
Aim
To identify the main differences in patients undergoing surgical correction of acquired mitral valve (MV) disease, depending on the type of pulmonary hypertension (PH) before surgery; to identify factors associated with the persistent PH and its type one year after surgical correction of MV disease.
Material and methods
In open, single-center prospective study the analysis of 40 patients with non-infectious valvular heart disease (VHD), undergoing MV correction, was performed. These patients had verified pulmonary hypertension according to the right heart catheterization (RHC): 15 patients with isolated post-capillary pulmonary hypertension and 25 patients with a combined post-/precapillary form of PH. During the surgery in 26 patients with PH the biopsy of the right lung tissue with subsequent microscopy was done. One year after the surgery the RHC was performed to assess the dynamics of PH. The values of the ranks of significance of predictors were used as an indicator of the contribution of a complex of factors to dynamics of PH after MV surgery.
Results
Patients with VHD and combined post/precapillary PH were characterized by more pronounced disturbances in the right ventricle-pulmonary artery coupling, increased levels of myocardial strain markers, severe changes in pulmonary circulation hemodynamics, arteriolization of venules, and a higher frequency of pandemic arterial thrombosis (53.3%) compared to patients with isolated postcapillary PH (9%). According to RHC data one year after surgery (n = 21), regression of PH was observed in 28.5%, isolated postcapillary PH persisted in 42.85%, and combined post/precapillary PH remained in 28.5%. The factors, that made the most significant contribution to PH regression one year after surgery included presence of mitral valve stenosis (100 units), atrial fibrillation presence (73 units), type 2 diabetes mellitus (72 units), combined intervention on the mitral valve and aortic valve (61 units), degree of obesity (56 units), male sex (48 units). The character of morphological lung changes did not significantly contribute to perioperative dynamics of PH.
Conclusion
Patients with mitral valve disease and combined post/precapillary PH are characterized by more pronounced disturbances in right ventricle-pulmonary artery coupling, elevated levels of myocardial strain markers, severe changes in pulmonary circulation hemodynamics with arteriolization of venules and a higher prevalence of pandemic arterial thrombosis. For the first time, potentially modifiable factors have been identified as making the greatest impact on the PH dynamics one year after surgery.Figure 1For image description, please refer to the figure legend and surrounding text.