Persistence of Severe Pulmonary Hypertension After Transcatheter Aortic Valve Replacement: Incidence and Prognostic Impact.
Severe pulmonary hypertension (PH) is considered to negatively affect the outcome after transcatheter aortic valve replacement. However, a clear understanding of the pattern, evolution, and clinical impact of different grades of PH in this setting is lacking.



A total of 990 consecutive patients were enrolled in 6 high-volume centers and analyzed as follows: group 1, systolic pulmonary artery pressure (sPAP) <40 mm Hg (346 patients; 35%); group 2, sPAP 40 to 60 mm Hg (426 patients; 43%); and group 3, sPAP >60 mm Hg (218 patients; 22%). At 1 month, mortality rate did not differ across the groups. When compared with groups 1 and 2, patients in group 3 had a higher-rate of New York Heart Association 3 to 4 (26% versus 12% and 10%), and a higher-rate of hospitalization for heart failure (7% versus 3% and 3%). At 1 year, when compared with patients in group 1, patients in group 2 and 3 had both a higher overall mortality (hazard ratio [HR], 1.5 [1.3-3.2]; P=0.01 and HR, 2.3 [1.8-2.8]; P=0.001) and a higher cardiac mortality (HR, 1.3 [1.1-2.1]; P=0.01 and HR, 1.7 [1.3-2.5]; P=0.002). After 1 month, the sPAP decreased ≥15 mm Hg in 32% and 35% of the patients in groups 2 and 3. Baseline sPAP >60 mm Hg (HR, 1.6 [1.1-2.3]; P=0.03) and, in a larger extent, a persistent severe PH after 1 month (HR, 2.4 [1.5-2.8]; P=0.004), independently predicted 1-year mortality, whereas the 1-month reduction of the sPAP did not.



The persistence of severe PH after transcatheter aortic valve replacement is a stronger predictor of 1-year mortality than baseline severe PH. The early reduction of sPAP is not associated with a reduced mortality. The benefit of transcatheter aortic valve replacement in terms of quality of life is substantial in patients with and without a reduction of sPAP at early follow-up.
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.). luctes@gmail.com.
Luca
L
Testa
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Azeem
A
Latib
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Federico
F
De Marco
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Marco
M
De Carlo
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Claudia
C
Fiorina
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Rocco
R
Montone
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Mauro
M
Agnifili
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Marco
M
Barbanti
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Anna Sonia
AS
Petronio
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Giuseppe
G
Biondi Zoccai
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Federica
F
Ettori
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Silvio
S
Klugmann
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Corrado
C
Tamburino
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Nedy
N
Brambilla
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Antonio
A
Colombo
From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
Francesco
F
Bedogni
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D062186:Arterial Pressure; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology; D061847:Hospitals, High-Volume; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
aortic valve stenosis; hypertension, pulmonary; transcatheter aortic valve replacement