Background
Methods
Study population
Echocardiography
Statistical analysis
Results
Variables | All patients (N = 154) | No PH (N = 113) | PH (N = 41) | P-value |
---|---|---|---|---|
Age (years) | 55.0 ± 16.4 | 53.4 ± 16.7 | 59.3 ± 14.8 | 0.050 |
Male gender | 93(60.4) | 69(61.1) | 24(58.5) | 0.777 |
Symptomatic | 58(37.7) | 34(30.1) | 24(58.5) | 0.001 |
BMI (kg/m2) | 22.8 ± 3.4 | 22.6 ± 3.4 | 23.2 ± 3.4 | 0.362 |
Hypertension | 61(39.6) | 43(38.1) | 18(43.9) | 0.512 |
Diabetes mellitus | 10(6.5) | 8(7.1) | 2(4.9) | 1.0 |
Dyslipidemia | 44(28.6) | 33(29.2) | 11(26.8) | 0.773 |
Smoking | 46(29.9) | 36(31.9) | 10(24.4) | 0.371 |
History of HF | 31(20.1) | 16(14.2) | 15(36.6) | 0.002 |
Prior stroke/TIA | 8(5.2) | 7(6.2) | 1(2.4) | 0.682 |
Betablocker | 46(30.3) | 31(27.9) | 15(36.6) | 0.302 |
ACEI/ARB | 56(36.8) | 39(35.1) | 17(41.5) | 0.473 |
Anticoagulant | 32(21.1) | 19(17.1) | 13(31.7) | 0.050 |
Diuretics | 65(42.8) | 38(34.2) | 27(65.9) | <0.001 |
Variables | Total (n = 154) | No PH (n = 113) | PH (n = 41) | P-value |
---|---|---|---|---|
RVSP (mmHg) | 43.2 ± 17.7 | 34.6 ± 7.3 | 66.8 ± 16.1 | <0.001 |
PAEDP (mmHg) | 14.1 ± 6.5 | 11.6 ± 3.8 | 20.8 ± 7.6 | <0.001 |
Mean PAP (mmHg) | 25.8 ± 10.3 | 21.5 ± 6.9 | 36.8 ± 9.5 | <0.001 |
PVR (Wood unit) | 2.5(1.0–9.0) | 2.2(1.0–25.2) | 4.0(1.9–9.0) | <0.001 |
EROA (mm2) | 61.8(22.0–250.9) | 55.9(22.0–250.9) | 87.5(27.0–225.1) | <0.001 |
RVol (ml) | 107.1 ± 51.8 | 99.1 ± 48.4 | 129.1 ± 55.2 | 0.001 |
Severe MR | 123(79.9) | 85(75.2) | 38(92.7) | 0.017 |
LVEF (%) | 68.1 ± 5.9 | 68.4 ± 5.9 | 67.2 ± 6.1 | 0.231 |
LAV (ml) | 109.8(44.5–653.4) | 94.3(44.5–486.3) | 147.1(70.9–653.4) | <0.001 |
LAV index (ml/m2) | 67.1(24.7–391.3) | 59.3(24.7–276.3) | 88.4(42.0–391.3) | <0.001 |
LA diameter (mm) | 52.9 ± 11.1 | 50.0 ± 9.6 | 60.8 ± 11.1 | <0.001 |
LVDd (mm) | 56.6 ± 6.7 | 56.2 ± 6.5 | 58.8 ± 6.3 | 0.029 |
LVSd (mm) | 33.8 ± 5.7 | 33.3 ± 5.9 | 35.2 ± 4.8 | 0.072 |
LVEDV (ml) | 113.3 ± 33.0 | 110.2 ± 32.2 | 122.0 ± 33.7 | 0.049 |
LVESV (ml) | 36.5 ± 13.6 | 35.0 ± 13.2 | 40.5 ± 13.9 | 0.027 |
LVMI (g/m2) | 146.4 ± 43.4 | 139.4 ± 38.5 | 165.7 ± 50.7 | 0.001 |
E (cm/sec) | 119.2 ± 33.8 | 108.7 ± 28.6 | 149.0 ± 29.8 | <0.001 |
A (cm/sec) | 70.8 ± 24.1 | 71.1 ± 24.7 | 69.3 ± 21.9 | 0.743 |
E/A | 1.8 ± 0.8 | 1.6 ± 0.7 | 2.3 ± 1.0 | <0.001 |
DT (ms) | 201.9 ± 48.6 | 208.5 ± 50.5 | 182.7 ± 37.1 | 0.005 |
E/E’ | 15.9 ± 6.1 | 14.4 ± 5.3 | 20.7 ± 6.0 | <0.001 |
TAPSE (mm) | 22.7 ± 4.5 | 23.3 ± 4.3 | 21.2 ± 5.0 | 0.011 |
St’ (cm/sec) | 12.2 ± 2.2 | 12.3 ± 2.0 | 11.7 ± 2.7 | 0.148 |
Symptom (n = 58) | No symptom (n = 96) | |||||
---|---|---|---|---|---|---|
Variables | No PH | PH | P-value | No PH | PH | P- value |
(n = 34) | (n = 24) | (n = 79) | (n = 17) | |||
Age (years) | 59.3 ± 15.7 | 56.9 ± 17.1 | 0.580 | 50.9 ± 16.6 | 62.6 ± 10.6 | 0.001 |
Male gender | 18(52.9) | 12(50.0) | 0.825 | 51(64.6) | 12(70.6) | 0.635 |
Hypertension | 20(58.8) | 9(37.5) | 0.110 | 23(29.1) | 9(52.9) | 0.059 |
Diabetes mellitus | 4(11.8) | 1(4.2) | 0.392 | 4(5.1) | 1(5.9) | 1.0 |
Dyslipidemia | 16(47.1) | 5(20.8) | 0.041 | 17(21.5) | 6(35.3) | 0.228 |
Smoking | 13(38.2) | 6(25.0) | 0.290 | 23(29.1) | 4(23.5) | 0.772 |
PAEDP (mmHg) | 12.6 ± 4.8 | 21.0 ± 7.5 | <0.001 | 11.3 ± 3.3 | 20.4 ± 8.0 | <0.001 |
EROA (mm2) | 51.0(23–251) | 98.4(36–207) | 0.001 | 56.1(22–162) | 70.5(27–225) | 0.250 |
RVol (ml) | 106.3 ± 63.1 | 138.6 ± 54.1 | 0.047 | 96.0 ± 40.5 | 115.5 ± 55.6 | 0.096 |
Severe MR | 24(70.6) | 23(95.8) | 0.019 | 62(78.5) | 15(88.2) | 0.510 |
LVEF (%) | 68.2 ± 6.43 | 65.9 ± 6.0 | 0.169 | 68.6 ± 5.6 | 69.0 ± 5.9 | 0.782 |
LAV (ml) | 93.3(50.5–286.8) | 156.3(86.4–653.4) | 0.001 | 97.2(44.5–486.3) | 133.4(70.9–197.9) | 0.002 |
LA index (ml/m2) | 57.4(30.3–178.9) | 98.0(54.3–391.3) | 0.001 | 60.1(24.7–276.3) | 74.1(42.0–114.1) | 0.004 |
LA diameter (mm) | 52.6 ± 8.7 | 63.1 ± 12.5 | <0.001 | 48.9 ± 9.9 | 57.6 ± 8.0 | 0.001 |
LVDd (mm) | 55.9 ± 7.2 | 60.2 ± 7.3 | 0.029 | 56.3 ± 6.3 | 56.7 ± 3.9 | 0.713 |
LVSd (mm) | 32.9 ± 6.8 | 36.8 ± 4.7 | 0.018 | 33.5 ± 5.6 | 32.9 ± 4.1 | 0.669 |
LVEDV (ml) | 104.7 ± 35.3 | 127.6 ± 34.2 | 0.017 | 112.6 ± 30.8 | 114.1 ± 32.3 | 0.855 |
LVESV (ml) | 33.6 ± 15.3 | 43.8 ± 13.8 | 0.012 | 35.7 ± 12.2 | 35.8 ± 13.0 | 0.959 |
LVMI (g/m2) | 155.6 ± 44.8 | 175.4 ± 56.9 | 0.144 | 132.3 ± 33.2 | 151.1 ± 36.5 | 0.046 |
E/E’ | 16.2 ± 5.7 | 21.0 ± 5.8 | 0.006 | 13.6 ± 5.0 | 20.4 ± 6.5 | <0.001 |
TAPSE (mm) | 22.2 ± 3.9 | 20.5 ± 5.4 | 0.183 | 23.7 ± 4.3 | 22.2 ± 4.4 | 0.185 |
St’ (cm/sec) | 12.2 ± 2.2 | 11.4 ± 2.8 | 0.212 | 12.4 ± 1.9 | 12.1 ± 2.5 | 0.551 |
Determinants of pulmonary hypertension
Factors | Crude odd ratio (95 % CI) | P-value | Adjusted odd ratio (95 % CI) | P-value |
---|---|---|---|---|
Age | 1.02 (1.00–1.06) | 0.053 | 1.03 (1.001–1.06) | 0.044 |
AF | 2.86 (1.34–6.08) | 0.006 | - | |
LVMI | 1.01 (1.01–1.02) | 0.002 | - | |
LVEDV | 1.01 (1.0–1.02) | 0.052 | - | |
LVESV | 1.03 (1.003–1.06) | 0.031 | - | |
LAV index | 1.02 (1.01–1.03) | 0.001 | 1.01 (1.001–1.02) | 0.037 |
TAPSE | 0.90 (0.82–0.98) | 0.013 | - | |
EROA | 1.02 (1.01–1.03) | <0.001 | 1.02 (1.01–1.03) | 0.006 |
Cut off of LAV index | Sensitivity (%) | Specificity (%) | LR + | LR - | PPV (%) | NPV(%) |
---|---|---|---|---|---|---|
≥60 ml/m2 | 92.7 (80.1–98.5) | 50.4 (40.9–60.0) | 1.9 (1.5–2.3) | 0.2 (0.1–0.4) | 40.4 (30.4–51.0) | 95.0 (86.1–99.0) |
≥65 ml/m2 | 85.4 (70.8–94.4) | 57.5 (47.9–66.8) | 2.0 (1.6–2.6) | 0.3 (0.1–0.5) | 42.2 (31.4–53.5) | 91.5 (82.5–96.8) |
≥70 ml/m2 | 70.7 (54.5–83.9) | 63.7 (54.1–72.6) | 2.0 (1.4–2.7) | 0.5 (0.3–0.8) | 41.4 (29.8–53.8) | 85.7 (76.4–92.4) |
Correlation between LAV index and pulmonary artery systolic pressure
Variables | Total (N = 154) | Symptom status | Severity of MR | ||||
---|---|---|---|---|---|---|---|
Symptomatic (N = 58) | Asymptomatic (N = 96) | P-value | Severe MR (N = 123) | Non-severe MR (N = 31) | P-value | ||
Symptomatic | 58 (37.7) | - | - | - | 46 (37.4) | 12 (38.7) | 1.0 |
Severe MR | 123(79.9) | 46 (79.3) | 77 (80.2) | 1.0 | - | - | - |
Age (years) | 55.0 ± 16.4 | 58.3 ± 16.2 | 53.0 ± 16.3 | 0.051 | 55.3 ± 16.1 | 53.9 ± 17.9 | 0.684 |
Male gender | 93(60.4) | 30(51.7) | 63(65.6) | 0.087 | 82(66.7) | 11(35.5) | 0.002 |
Atrial fibrillation | 45(29.4) | 25(43.1) | 20(21.1) | 0.004 | 34(27.9) | 11(35.5) | 0.406 |
LVDd (mm) | 56.9 ± 6.6 | 57.7 ± 7.5 | 56.3 ± 5.9 | 0.245 | 58.3 ± 6.3 | 51.1 ± 4.1 | <0.001 |
LVSd (mm) | 33.8 ± 5.7 | 34.5 ± 6.3 | 33.4 ± 5.3 | 0.238 | 34.5 ± 5.8 | 31.0 ± 4.4 | <0.001 |
LVEDV (ml) | 113.3 ± 33.0 | 114.2 ± 36.4 | 112.8 ± 30.9 | 0.810 | 119.5 ± 32.3 | 89.0 ± 22.9 | <0.001 |
LVESV (ml) | 36.5 ± 13.6 | 37.8 ± 15.5 | 35.7 ± 12.3 | 0.382 | 38.0 ± 13.8 | 30.4 ± 10.5 | 0.005 |
LVMI (g/m2) | 146.4 ± 43.44 | 163.8 ± 50.7 | 135.5 ± 34.3 | <0.001 | 154.6 ± 42.5 | 113.3 ± 29.8 | <0.001 |
E/E’ | 15.9 ± 6.1 | 18.0 ± 6.1 | 14.8 ± 5.9 | 0.002 | 16.6 ± 6.2 | 13.3 ± 5.0 | 0.008 |
TAPSE (mm) | 22.7 ± 4.6 | 21.5 ± 4.6 | 23.4 ± 4.4 | 0.010 | 22.9 ± 4.5 | 22.0 ± 4.9 | 0.307 |
EROA (mm2) | 61.8(22.0–250.9) | 78.7(23.0–250.9) | 56.5(22.0–225.1) | 0.080 | 72.0(40.0–250.9) | 28.9(22.0–44.9) | <0.001 |
RVol (ml) | 102.1(20.3–336.2) | 114.8(36.2–336.2) | 95.5(20.3–267.9) | 0.058 | 113.3(61.3–336.2) | 48.1(20.3–75.0) | <0.001 |
LAV index (ml/m2) | 67.1(24.7–391.3) | 80.4(30.3–391.3) | 62.5 (24.7–276.3) | 0.007 | 71.7(30.3–391.3) | 46.3(24.7–145.0) | <0.001 |
RVSP (mmHg) | 43.2 ± 17.7 | 49.0 ± 18.0 | 39.6 ± 16.5 | 0.001 | 44.9 ± 18.7 | 36.3 ± 10.4 | 0.001 |