Echocardiographic predictors of pulmonary hypertension in patients with severe aortic stenosis
Division of Cardiology, Loma Linda University Medical Center, 1234 Anderson Street, #4414, Loma Linda, CA 92354, USA
Received 27 October 2006; accepted after revision 20 January 2007; online publish-ahead-of-print 20 March 2007.
* Corresponding author. Tel: +1 909 558 9730; fax: +1 909 558 0903. E-mail address: ramdaspai{at}yahoo.com
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Abstract |
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Background: Pulmonary hypertension complicating severe aortic stenosis increases morbidity and mortality. Causes and mechanisms of this are unclear.
Methods: This is a retrospective observational study of 626 patients with severe aortic stenosis who had measurable pulmonary arterial pressure by Doppler echocardiography. Clinical, echocardiographic and pharmacological data were related to the presence of pulmonary hypertension.
Results: Of the 626 patients, 119 (19%) had severe pulmonary hypertension defined as pulmonary artery systolic pressure 
60 mmHg. Patients with severe pulmonary hypertension had a smaller aortic valve area (P < 0.0001), a lower left ventricular ejection fraction (P < 0.0001), a higher mitral E/A velocity ratio (P < 0.0001) indicating a higher filling pressure and a higher prevalence of 3 or 4+ mitral regurgitation (P < 0.001). They were less likely to be on a beta blocker (P = 0.05) or a statin (P = 0.02). Smaller aortic valve area, left ventricular dysfunction, mitral regurgitation and lack of statin use were independent predictors of severe pulmonary hypertension.
Conclusions: Severity of aortic stenosis, left ventricular dysfunction, and mitral regurgitation are risk factors for the genesis of pulmonary hypertension and statins may potentially be protective in patients with severe aortic stenosis.
Keywords: Aortic stenosis; Pulmonary hypertension; Statin; Echocardiography