title: Echocardiographic pulmonary hypertension probability is associated with clinical outcomes after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Pulmonary hypertension (PH) is associated with mortality after transcatheter aortic valve implantation (TAVI). However, diagnosis based on tricuspid regurgitant velocity (TRV) is often inaccurate and unreliable. The updated PH guidelines introduced a PH probability grading implementing additional PH signs on transthoracic echocardiography (TTE), from which we aimed to analyse its effects on clinical outcomes in patients undergoing TAVI.
  
  
  RESULTS
  We included 591 consecutive patients (mean age 80.2±8.4years, 58.0% female, mean STS risk score 6.2±3.8%) undergoing TAVI. Patients were divided into "low" (n=270; TRV ≤2.8m/s without additional PH signs), "intermediate" (n=131; TRV ≤2.8m/s with additional PH signs, or TRV 2.9-3.4m/s without additional PH signs), and "high" PH probability (n=190; TRV 2.9-3.4m/s with additional PH signs, or TRV >3.4m/s). The overall 30-day and 2-year mortality rates were 10.2% and 33.8%, respectively. "High" PH probability was an independent predictor of mortality at 30days (HR 3.68, 95% CI 2.03 to 6.67, p<0.01) and 2years (HR 2.19, 95% CI 1.57 to 3.04, p<0.01), compared to "low" PH probability. The "intermediate" group did not show an increased risk. The presence of additional PH signs resulted in a significantly higher mortality at 30days (19.6% vs. 5.1%, p<0.01) and two years (54.2% vs. 22.5%, p<0.01).
  
  
  CONCLUSIONS
  The updated echocardiographic PH probability model incorporating additional PH signs independently predicts early and late mortality after TAVI. Additional PH signs are of great value in assessing one's risks since its presence is strongly associated with early and late mortality.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: v.nijenhuis@antoniusziekenhuis.nl.
authors.forename: V J
authors.initials: VJ
authors.lastname: Nijenhuis
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: Huitema
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: V M M
authors.initials: VM
authors.lastname: Vorselaars
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Swaans
authors.affiliation: Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: de Kroon
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: J A S
authors.initials: JA
authors.lastname: van der Heyden
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: B J W M
authors.initials: BJ
authors.lastname: Rensing
authors.affiliation: Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Heijmen
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Ten Berg
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Post
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D004452:Echocardiography / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D008297:Male; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000639:trends*; D016896:Treatment Outcome
keywords: Acute kidney injury; Aortic stenosis; Outcomes; Prognosis; Pulmonary hypertension (PH); Transcatheter aortic valve implantation (TAVI)