Impact of preoperative exercise pulmonary hypertension on postoperative outcome in asymptomatic patients with primary mitral regurgitation: a multicenter study
Bibliographic record
Abstract
Introduction: The management and the timing of surgery of asymptomatic patients with primary mitral regurgitation (MR) remain controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid and frequent occurrence of symptoms, leading to surgery. However, the postoperative outcome of patients with ExPHT is unknown. We aimed to describe the postop. outcome of patients with primary MR, purposely according to the presence of preop. ExPHT. Method: We prospectively included 129 asymptomatic patients (70% male, 68±12 yrs) with primary MR and no left ventricular dysfunction/dilatation, in whom we performed exercise echocardiography, in 3 centers (Fr, Bel and Can). Patients with concomitant >mild other valve disease or atrial fibrillation (AF) were excluded. The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60mmHg. All patients were closely followed up and operated when indication for surgery, according to most recent guidelines, was reached. Postop. events were defined as the occurrence of AF, stroke, cardiac-related hospitalization or death. Results: Among the 129 patients included, 70 have developed ExPHT (54%) and these patients were significantly older than those without ExPHT (70±11 vs. 64±14, p=0.03). There was no difference between the 2 groups regarding gender distribution, baseline LV ejection fraction, left atrial volume or MR severity. Only 15 patients underwent mitral valve replacement (12%), without significant difference between the 2 groups (ExPHT: 10% vs. no ExPHT: 14%, p=0.55). The 114 remaining patients had successful mitral valve repair. Following surgery, 28 predefined end-point were reached (22%): 17 (61%) postop. AF, 5 (18%) strokes, 3 (11%) cardiac-related hospitalization and 3 (11%) cardiac deaths. Of interest, patients with ExPHT had significant higher rate of postop. cardiac event (82% vs. 18%, p=0.0006) and all strokes occurred in ExPHT group. Using multivariate analysis, after adjustment for age, gender and preoperative NYHA functional class, ExPHT was independently associated with higher risk of postop. cardiovascular events (odds-ratio: 5.4, 95% of confidence interval: 1.8-20, p=0.002). Conclusion: The present study show that ExPHT is associated with reduced postop. event-free survival in asymptomatic patients with primary MR and no LV dysfunction/dilatation. These results emphasize the use of exercise echocardiography and suggest that early surgery could be considered to improve the outcome of these patients. Nevertheless, further data are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".