Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Abstract

Background-Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis. The aim of this multicenter study was to describe clinical outcome after transcatheter aortic valve implantation. Methods and Results-The FRANCE 2 Registry included all patients undergoing transcatheter aortic valve implantation in France in 2010 and 2011. Patients were divided into 3 groups depending on systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP <40 mm Hg (no PH); group II, sPAP 40 to 59 mm Hg (mildto-moderate PH); and group III, sPAP ≥60 mm Hg (severe PH). Patients were followed up for 1 year. A total of 2435 patients whose pre-transcatheter aortic valve implantation sPAP was reported were included. A total of 845 were in group I (34.7%), 1112 in group II (45.7%), and 478 in group III (19.6%). Procedural success, early complications, and 30-day mortality were statistically similar across sPAP groups. One-year mortality was higher in groups II and III (group I, 22%; group II, 28%; and group III, 28%; P=0.032). Mild-to-moderate and severe PH were identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. New York Health Association functional class improved significantly in all groups. Conclusions-PH (sPAP ≥40 mm Hg) in patients with aortic stenosis undergoing transcatheter aortic valve implantation was associated with increased 1-year mortality especially when severe (sPAP ≥60 mm Hg) but not with increased 30-day mortality, and functional status was significantly improved regardless of PAP level. (Circ Cardiovasc Interv. 2014;7:240-247.)

Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

“…32 Among TAVI patients, previous studies reported PH to be an independent predictor of late, rather than early, mortality after the procedure. 7,8 Tamburino et al 7 reported that PASP >60 mm Hg was an independent predictor of overall, but not early, mortality among patients with severe AS undergoing TAVI. Similarly, in a subanalysis of the French Aortic National CoreValve and Edwards (FRANCE 2) Registry (n=2435), Lucon et al 8 observed no significant effect of PH severity on 30-day mortality, but severe PH (PASP, >60 mm Hg) was an independent predictor of 1-year mortality.…”

“…6 Previous studies have shown PH to be a predictor of mortality after TAVI. [7][8][9][10][11] However, studies to date have focused mainly on PH severity rather than hemodynamic presentation and used noninvasive measurements of pulmonary artery systolic pressure (PASP), which correlate only modestly with invasive measurements.12 According toBackground-Pulmonary hypertension (PH) frequently coexists with severe aortic stenosis, and PH severity has been shown to predict outcomes after transcatheter aortic valve implantation (TAVI). The effect of PH hemodynamic presentation on clinical outcomes after TAVI is unknown.…”

Prevalence and Prognostic Significance of Right Ventricular Systolic Dysfunction in Patients Undergoing Transcatheter Aortic Valve Implantation

“…30 However, to the best of our knowledge, this is the first description of RVSD as an independent predictor of mortality after TAVI. The finding of higher pulmonary artery pressures in patients with RVSD, and a negative correlation between RVEF and pulmonary artery pressure, is in keeping with previous literature showing that RV dysfunction is a predictor of clinical outcomes in patients with pulmonary hypertension.…”

Interventional Cardiology

“…Other clinical features associated with reduced survival include the presence of tricuspid insufficiency, right heart failure, body mass index <20 kg/m 2 , and pulmonary hypertension. [67][68][69] These reports suggest that, from a technical standpoint, TAVR can be performed with reasonable shortterm safety, in comparison with surgery, even in high-risk patients with advanced aortic stenosis.…”