Functional Mitral Regurgitation: A Link to Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction

Abstract Background Patients with heart failure with preserved ejection fraction (HFpEF) may present with Pulmonary hypertension (PH) and functional mitral regurgitation (MR). Whether PH is linked to the presence of functional MR has not been investigated in HFpEF patients. Methods and Results Systolic pulmonary artery pressure (sPAP) and functional MR were assessed by 2-dimensional Doppler echocardiography in 70 ambulatory HFpEF patients and 70 hypertensive control subjects free of organic mitral valve lesions, significant valve disease, and comorbid conditions associated with PH. Whereas none of control subjects had more than trivial MR, 21 patients with HFpEF had functional MR (mean mitral effective regurgitant orifice, regurgitant volume, and regurgitant fraction 7 ± 3 mm, 2 15 ± 8 mL, and 28 ± 14%, respectively). Pulmonary hypertension (sPAP >35 mm Hg) was significantly more prevalent in HFpEF patients with functional MR than in HFpEF patients without functional MR (62 vs 22%; P  = .002). Functional MR remained an independent predictor of PH in HFpEF patients ( P  = .004) after adjustment on mitral E wave to e′ mitral annulus velocity ratio (E/e′; P  = .022) and left atrial volume index ( P  = .025). Systolic PAP and E/e′ were greater in HFpEF patients than in control subjects (35 ± 9 vs 29 ± 8 mm Hg [ P P  = .018], respectively). Systolic PAP remained greater in HFpEF patients than in control subjects after adjusting for E/e′ ( P  = .002). Conclusions Pulmonary hypertension appears to be linked to the presence of functional MR in HFpEF patients.