title: Incidence, predictors, and impact on prognosis of systolic pulmonary artery pressure and its improvement after transcatheter aortic valve implantation: a multicenter registry.
abstract: OBJECTIVE
  Elevated values of systolic pulmonary artery pressure (sPAP) represent a common finding in patients with aortic stenosis and severe left ventricular hypertrophy. Prognostic impact of sPAP and its potential improvement after transcatheter aortic valve implantation (TAVI) remains to be determined.
  
  
  RESULTS
  This is a multicenter retrospective registry in five European institutions. All consecutive patients undergoing TAVI were enrolled, and divided into two groups according to sPAP evaluated with echocardiography: ≤40 mm Hg and >40 mm Hg. All-cause mortality at follow-up of at least 1 year was the primary endpoint, while 30-day mortality, periprocedural complications, myocardial infarction, stroke, and reintervention rates at follow-up were the secondary endpoints. Among 674 patients enrolled, a total of 319 (47%) had sPAP >40 mm Hg. This was associated with higher mortality at 30 days (4.5% vs 8.5%; P=.03) and at a median follow-up of 477 days (17% vs 26%; P=.03). Improvement of sPAP was reported in 113 patients (27%), occurring more frequently in absence of moderate or severe mitral regurgitation and of right ventricle dysfunction. With multivariate adjustment, reduced renal function, insulin-dependent diabetes mellitus, and sPAP >40 mm Hg were independent predictors of all-cause mortality, improvement in sPAP values was related to a better survival, while ejection fraction was not.
  
  
  CONCLUSIONS
  Elevated values of sPAP represent a common finding in patients undergoing TAVI. This parameter, along with its improvement, may be used to stratify risk and determine prognosis for patients undergoing TAVI.
authors: Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Corso Bramante 88-90, 10126 Turin, Italy. fabrizio.dascenzo@gmail.com.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Federico
authors: F
authors: Conrotto
authors: Stefano
authors: S
authors: Salizzoni
authors: Marco Luciano
authors: ML
authors: Rossi
authors: Freek
authors: F
authors: Nijhoff
authors: Valeria
authors: V
authors: Gasparetto
authors: Marco
authors: M
authors: Barbanti
authors: Marco
authors: M
authors: Mennuni
authors: Pierluigi
authors: P
authors: Omedè
authors: Walter
authors: W
authors: Grosso Marra
authors: Giorgio
authors: G
authors: Quadri
authors: Francesca
authors: F
authors: Giordana
authors: Corrado
authors: C
authors: Tamburino
authors: Giuseppe
authors: G
authors: Tarantini
authors: Patrizia
authors: P
authors: Presbitero
authors: Massimo
authors: M
authors: Napodanno
authors: Pieter
authors: P
authors: Stella
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Pierfrancesco
authors: P
authors: Agostoni
authors: Maurizio
authors: M
authors: D'Amico
authors: Claudio
authors: C
authors: Moretti
authors: Mauro
authors: M
authors: Rinaldi
authors: Sebastiano
authors: S
authors: Marra
authors: Fiorenzo
authors: F
authors: Gaita
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome