Pulmonary Hypertension in Mitral Regurgitation
www.ahajournals.org
May 8, 2022, 9:09 a.m.
Mitral regurgitation (MR) is the most common valvular lesion in the United States and the second‐most common valvular lesion requiring surgery in Europe. In the United States, over 2.5 million people are estimated to have moderate‐to‐severe MR, and this number is expected to double by 2030. Over the past several decades, improvements in our ability to diagnose and quantify MR, coupled with a better understanding of its natural history and the adverse prognostic features, has led to the refinement of indications for mitral valve surgery. Pulmonary hypertension (defined as a systolic pressure >50 mm Hg at rest or >60 mm Hg with exercise) is one such adverse prognostic indicator, the presence of which in patients with asymptomatic MR translates to a class IIA indication for mitral valve surgery according to the latest American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines. Pulmonary hypertension has long been known to be a serious complication of mitral valve disease (MVD). Yet, its precise role in the natural history and management of patients with MR remains scantly investigated, as exemplified by a level of evidence C associated with the above‐mentioned recommendation for surgery.