Author + information
- Received December 30, 1988
- Revision received March 1, 1989
- Accepted March 15, 1989
- Published online August 1, 1989.
- Dimitrios Alexopoulos, MD∗,
- Charles Lazzam, MD,
- Susan Borrico, BS,
- Lizabeth Fiedler, BA and
- John A. Ambrose, MD, FACC
- ↵∗Address for reprints: John A. Ambrose, MD. Division of Cardiology, Box 1030, Mount Sinai Medical Center. One Gustave L. Levy Place, New York. New York 10029.
Pulmonary hypertension in chronic mitral valve disease has been related most commonly to left ventricular dysfunction or mitral stenosis; its association with chronic, isolated mitral regurgitation and preserved left ventricular systolic function is unclear. In 41 catheterized patients with chronic mitral regurgitation (known history of mitral regurgitation for >18 months) and preserved left ventricular systolic function (ejection fraction >0.55), historic, electrocardiographic, echocardiographic and hemodynamic variables were analyzed. Ten patients (Group 1) had normal pulmonary artery systolic pressure (>30 mm Hg), whereas 31 patients had pulmonary hypertension. Pulmonary artery systolic pressure was mildly increased (30 to 49 mm Hg) in 13 patients (Group II) and was >50 mm Hg in 18 patients (Group III).
Univariate analysis showed the more frequent occurrence of male gender and ruptured chordae tendineae in the groups with pulmonary hypertension. Mean pulmonary capillary wedge pressure, size of the V wave in pulmonary capillary wedge pressure and pulmonary arteriole resistance were higher, whereas cardiac index was lower in the hypertension groups. Multivariate stepwise analysis revealed higher mean pulmonary capillary wedge pressure and pulmonary arteriole resistance as the only variables independently differing among groups.
In conclusion, pulmonary hypertension occurs frequently (76% of cases) in patients with chronic, isolated mitral regurgitation with preserved left ventricular systolic function. In these patients, a severe increase in pulmonary capillary wedge pressure is associated with elevation in pulmonary artery resistance, a finding similar to that in mitral stenosis.
☆ This project was conducted by the New York Cardiac Center in association with the Mount Sinai Medical Center. Dr. Alexopoulos is an Annenberg Scholar in Cardiology.
- Received December 30, 1988.
- Revision received March 1, 1989.
- Accepted March 15, 1989.