AUTHOR=Zheng Tie , Zhao Yichen , Ye Qing , Zheng Shuai , Meng Fei , Hu Qiuming , Zhang Haibo , Han Jie , Tian Baiyu , Zhu Junming , Wang Jiangang 

TITLE=Impact of pulmonary arterial systolic pressure on patients with mitral valve disease combined with atrial fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1047715

DOI=10.3389/fcvm.2022.1047715

ISSN=2297-055X

ABSTRACT=Objective: To determine whether different changes of pulmonary artery systolic pressure (PASP) after surgeries have an impact on the long-term outcomes in patients with rheumatic and degenerative mitral valve (MV) disease and atrial fibrillation.
Methods: Between 2004 and 2016, 1188 patients with rheumatic and degenerative MV disease undergoing MV and Cox-Maze procedure were identified. Clinic outcomes, as well as rhythm state and echocardiography indices in long-term follow-up were recorded. Patients were grouped by the changes of PASP (persistently normal, persistently increased, increased and decreased) from preoperative estimation to follow-up.
Results: A complete echocardiography was performed at baseline and after 5 years.  During follow-up, free of death and atrial fibrillation (AF) off antiarrhythmic drugs was 90% and 61%, 78% and 41% at 5 years and 10 years, respectively. Survival rate was higher in patients with persistently normal and became worse in patients with persistently increased and increased PASP (log-rank 166.0, P < 0.0001). Moreover, the patients with persistently normal PASP had a lowest risk of recurrent AF (SHR:0817; CI:0.765–0.872; P < 0.0001) after considering death as a competing risk. A persistently normal PASP at follow-up and degenerative MV disease were associated with improved survival and sinus rhythm (SR) maintenance at multivariable Cox regression analysis (P < 0.05). 
Conclusions: Patients with degenerative MV disease or have persistently normal PASP during follow-up have better survival and SR maintenance rate than patients with either rheumatic MV disease or persistently abnormal PASP.