RT Journal Article
T1 Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival.
A1 Bermejo, Javier
A1 González-Mansilla, Ana
A1 Mombiela, Teresa
A1 Fernández, Ana I
A1 Martínez-Legazpi, Pablo
A1 Yotti, Raquel
A1 García-Orta, Rocío
A1 Sánchez-Fernández, Pedro L
A1 Castaño, Mario
A1 Segovia-Cubero, Javier
A1 Escribano-Subias, Pilar
A1 Alberto San Román, J
A1 Borrás, Xavier
A1 Alonso-Gómez, Angel
A1 Botas, Javier
A1 Crespo-Leiro, María G
A1 Velasco, Sonia
A1 Bayés-Genís, Antoni
A1 López, Amador
A1 Muñoz-Aguilera, Roberto
A1 Jiménez-Navarro, Manuel
A1 González-Juanatey, José R
A1 Evangelista, Arturo
A1 Elízaga, Jaime
A1 Martín-Moreiras, Javier
A1 González-Santos, José M
A1 Moreno-Escobar, Eduardo
A1 Fernández-Avilés, Francisco
A1 SIOVAC (“Sildenafil for Improving Outcomes after VAlvular Correction”) Investigators, 
K1 heart failure
K1 pulmonary hypertension
K1 valvular heart disease
AB 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. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.
YR 2021
FD 2021-01-05
LK http://hdl.handle.net/10668/16919
UL http://hdl.handle.net/10668/16919
LA en
DS RISalud
RD Apr 8, 2025