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

ABSTRACT 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.