{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:46:06Z","timestamp":1791945966956,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T00:00:00Z","timestamp":1686009600000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Health and Medical Research Council of Australia","award":["1055214, 11358940"],"award-info":[{"award-number":["1055214, 11358940"]}]},{"name":"Heart Research Institute Australia","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,5,18]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Pulmonary hypertension (PHT) commonly coexists with significant mitral regurgitation (MR), but its prevalence and prognostic importance have not been well characterised. In a large cohort of adults with moderate\u2009or greater MR, we aimed to describe the prevalence and severity of PHT and assess its influence on outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000 to 2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction &gt;50%\u2009and with moderate or greater MR were included (n=9683). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes was evaluated (median follow-up of 3.2 years, IQR 1.3\u20136.2 years).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Subjects were aged 76\u00b112\u2009years, and 62.6% (6038) were women. Overall, 959 (9.9%) had no PHT, and 2952 (30.5%), 3167 (32.7%), 1588 (16.4%) and 1017 (10.5%) patients had borderline, mild, moderate and severe PHT, respectively. A \u2018typical left heart disease\u2019 phenotype was identified with worsening PHT, showing rising E:e\u2032, right and left atrial sizes increasing progressively, from no PHT to severe PHT (p&lt;0.0001, for all). With increasing PHT severity, 1- and 5-year actuarial mortality increased from 8.5% and 33.0% to 39.7% and 79.8%, respectively (p&lt;0.0001). Similarly, adjusted survival analysis showed the risk of long-term mortality progressively increased with higher eRVSP levels (adjusted HR 1.20\u20132.86, borderline to severe PHT, p&lt;0.0001 for all). A mortality inflection was apparent at an eRVSP level &gt;34.00\u2009mm Hg (HR 1.27, CI 1.00\u20131.36).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this large study, we report on the importance of PHT in patients with MR. Mortality increases as PHT becomes more severe from an eRVSP of 34\u2009mm Hg onwards.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002268","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T03:54:21Z","timestamp":1686110061000},"page":"e002268","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4260-2793","authenticated-orcid":false,"given":"Seshika","family":"Ratwatte","sequence":"first","affiliation":[{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoff","family":"Strange","sequence":"additional","affiliation":[{"name":"Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia"},{"name":"Heart Research Institute Ltd, Newtown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Playford","sequence":"additional","affiliation":[{"name":"Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Stewart","sequence":"additional","affiliation":[{"name":"Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia"},{"name":"School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S","family":"Celermajer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,6]]},"reference":[{"key":"2025081711044099000_10.1.e002268.1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.113.000748","article-title":"Pulmonary hypertension in mitral regurgitation","volume":"3","author":"Patel","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2025081711044099000_10.1.e002268.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"2025081711044099000_10.1.e002268.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.086"},{"key":"2025081711044099000_10.1.e002268.4","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1093\/ehjqcco\/qcab082","article-title":"Mitral regurgitation management: a systematic review of clinical practice guidelines and recommendations","volume":"8","author":"Galusko","year":"2022","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2025081711044099000_10.1.e002268.5","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(89)90180-0"},{"key":"2025081711044099000_10.1.e002268.6","first-page":"167","article-title":"Prognostic significance of exercise induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation","volume":"6","author":"Kusunose","year":"2013","journal-title":"Circ: Cardiovascular Imaging"},{"key":"2025081711044099000_10.1.e002268.7","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq294"},{"key":"2025081711044099000_10.1.e002268.8","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.186486"},{"key":"2025081711044099000_10.1.e002268.9","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01897-2018"},{"key":"2025081711044099000_10.1.e002268.10","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-301992"},{"key":"2025081711044099000_10.1.e002268.11","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv512"},{"key":"2025081711044099000_10.1.e002268.12","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2018.00040","article-title":"Pulmonary hypertension in aortic and mitral valve disease","volume":"5","author":"Maeder","year":"2018","journal-title":"Front Cardiovasc Med"},{"key":"2025081711044099000_10.1.e002268.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.07.001"},{"key":"2025081711044099000_10.1.e002268.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.482"},{"key":"2025081711044099000_10.1.e002268.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.08.004"},{"key":"2025081711044099000_10.1.e002268.16","doi-asserted-by":"crossref","unstructured":"Ratwatte S , Stewart S , Strange G , et al . 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