title: Prevalence and impact of pulmonary hypertension on patients with aortic stenosis who underwent transcatheter aortic valve replacement.
abstract: Limited amount of data suggest that patients with aortic stenosis and pulmonary hypertension (PH) who undergo transcatheter aortic valve replacement (TAVR) experience decrease in PH postprocedure. Inconsistent use of systolic pulmonary artery pressure cut-off values in previous studies limits our ability to draw meaningful conclusions regarding the prognostic role of PH in assessment of TAVR candidates. A total of 415 consecutive patients who underwent TAVR were included in the present study. Two groups were compared based on receiver-operating characteristics curve analysis for the best SPAP value to predict outcome, yielding 2 study groups of no/mild PH (≤50 mm Hg; n = 172, 41%) versus moderate/severe PH (>50 mm Hg; n = 243, 59%). Demographics and co-morbidities were comparable between the 2 groups; however, right-sided cardiac failure (35% vs 19.8%, p = 0.02) and mitral regurgitation (18.4% vs 8.6%, p = 0.007) were more frequent in patients with moderate/severe PH. Procedural characteristics and complications were comparable between the groups. Although there was an early overall decrease in SPAP postprocedure, only 26% of moderate/severe patients with PH experienced a significant decrease in SPAP (>10 mm Hg). The 30-day (14.5% vs 7.4%, p = 0.02) and 1-year mortality (30.8% vs 21%, p = 0.02) was higher in moderate/severe patients with PH. In multivariate analysis, systolic pulmonary artery pressure and chronic lung disease were identified as independent predictors for mortality at 1 year. PH is a frequent co-morbidity in patients with severe aortic stenosis who underwent TAVR. Significantly elevated pulmonary artery pressures at baseline may serve as a poor prognostic factor when performing preprocedural assessment of the patients.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Ramat-Gan, Israel.
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Goldstein
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Zuyue
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Petros
authors.initials: P
authors.lastname: Okubagzi
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D004219:District of Columbia / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*