title: Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: study from the FRANCE 2 Registry.
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.
  
  
  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 (mild-to-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.
authors.affiliation: From the Service de Cardiologie (A.L., M.B., D.B., H.L.B.), Service de Pharmacologie Clinique (E.O.), and Service de Chirurgie Thoracique et Cardiovasculaire (J.P.V., A.L.), CHU Rennes, Rennes, France; Département de Pharmacologie, Clinique et Expérimentale, Faculté de Médecine (E.O.) and LTSI (J.P.V., H.L.B.), Université de Rennes 1, Rennes, France; INSERM 0203, Centres d'Investigation Clinique, Rennes, France (E.O.); INSERM, U642, Rennes, France (J.P.V., H.L.B.); CHU Rouen, Hôpital Charles Nicolle, INSERM Unité 1096, Rouen, France (H.E.); CHU Bichat, Paris, France (B.I.); CHU Dupuytren, Limoges, France (M.L.); CHU Pitié-Salpêtrière, Paris, France (P.L.); and CHU Brest, Brest, France (M.G.).
authors.forename: Adrien
authors.initials: A
authors.lastname: Luçon
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis*; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: aortic valve stenosis; hypertension, pulmonary