Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes

Abstract Background Pulmonary hypertension (PHT) commonly co-exists with significant mitral regurgitation (MR), but its prevalence and prognostic importance has not been well documented. Purpose In a large cohort of adults with ≥moderate MR, we aimed to describe the prevalence and severity of PHT and assess its influence on outcomes. Methods We analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) >50% and with moderate or greater MR were included (n= 9683). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.2 years, interquartile range 1.3-6.2years). Results Subjects were aged 76±12years and 62.6% (6038) were female. Overall, 959 (9.9%) had no PHT; and 2952 (30.5%), 3167 (32.7%), 1588(16.4%) and 1017 (10.5%) patients had borderline, mild, moderate and severe PHT respectively. A "typical left heart disease" phenotype was identified with worsening PHT, showing rising E:e’, right and left atrial sizes increasing progressively, from no PHT to severe PHT (p