title: Prognostic value of mild-to-moderate pulmonary hypertension in patients with severe aortic valve stenosis undergoing aortic valve replacement.
abstract: BACKGROUND
  Optimal timing of elective aortic valve replacement (AVR) for severe aortic stenosis (AS) is challenging. Hence, a sensitive marker in AS patients indicating increasing risk after AVR would be of great clinical value. In the present study, we hypothesized that mild-to-moderate pulmonary hypertension (PH) assessed prior to AVR is a sensitive marker for adverse events in patients after successful AVR.
  
  
  METHODS
  We enrolled 200 consecutive patients with severe AS undergoing AVR. Among them, 176 patients (88%) were symptomatic. Patients were divided according to systolic pulmonary artery pressure (PAP(sys)) into three groups: no PH (PAP(sys) <30 mmHg), mild-to-moderate PH (PAP(sys) ≥30 and PAP(sys) <60 mmHg) and severe PH (≥60 mmHg). Multivariable analyses were adjusted for age and gender and included PH, left ventricular ejection fraction ≤35%, renal insufficiency and logistic EuroSCORE ≥20%. Primary endpoint was death of any cause within 5 years after AVR.
  
  
  RESULTS
  During follow-up, 23 patients died (cumulative 5-year mortality rate 14.6%). Patients without (n = 78), mild-to-moderate (n = 99) and severe PH (n = 23) had 5-year mortality rates of 2.6, 15.2 and 26.1% (p = 0.001). PAPsys ≥30 mmHg yielded an excellent level of sensitivity of 92.8%. On multivariable analysis, mild-to-moderate PH was the only independent risk factor (hazard ratio 4.9, 95% confidence interval 1.1-21.8).
  
  
  CONCLUSIONS
  In patients with severe AS undergoing AVR, mild-to-moderate PH is a strong and independent predictor of late mortality. Conversely, patients with normal PAP(sys) have an extremely good prognosis.
authors.affiliation: Innere Medizin III, Kardiologie und Herz-/Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Zuern
authors.forename: Christian
authors.initials: C
authors.lastname: Eick
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Rizas
authors.forename: Cosmina
authors.initials: C
authors.lastname: Stoleriu
authors.forename: Barbara
authors.initials: B
authors.lastname: Woernle
authors.forename: Stephen
authors.initials: S
authors.lastname: Wildhirt
authors.forename: Christian
authors.initials: C
authors.lastname: Herdeg
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stock
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome