Impact of Right Heart Catheterization and the 2022 ESC/ERS Definition of Pulmonary Hypertension in Patients With Mitral Regurgitation Undergoing Valve Repair/Replacement.

In patients with mitral regurgitation (MR), the role of invasive hemodynamics is not well defined. We evaluated the value of right heart catheterization (RHC) and the 2022 ESC/ERS pulmonary hypertension (PH) definition prior to a mitral valve procedure for the prediction of PH several months thereafter. We studied 274 patients (mean age 68 ± 11 years) with at least moderate MR (84% degenerative, 11% functional, 5% combined) undergoing RHC (baseline) followed by surgical (70%) or transcatheter (30%) valve repair/replacement who had an echocardiogram after a median follow-up of 3 months. PH was defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg and was subclassified by mean pulmonary artery wedge pressure (mPAWP) and pulmonary vascular resistance (PVR). The PH follow-up probability was assessed by peak tricuspid regurgitant velocity and indirect PH signs. At baseline, 143/274 (52%) patients had any PH: 40 had isolated post-capillary, 65 had combined pre- and post-capillary (CpcPH), 27 had pre-capillary, and 11 had unclassified PH. Follow-up PH probability was low in 149, intermediate in 73, or high in 42 patients. There was a progressive increase in baseline mPAP, mPAWP, and PVR (p < 0.001 for all) in patients with low, intermediate or high follow-up PH probability. Patients with baseline CpcPH had a nearly 11-fold higher risk (odds ratio 10.7) for a high follow-up PH probability compared to those without PH. In conclusion, in MR patients the hemodynamic constellation according to the 2022 ESC/ERS PH definition predicts the PH probability several months after a mitral valve procedure.