Persistence of severe pulmonary hypertension after transcatheter aortic valve replacement: Incidence and prognostic impact

Luca Testa, Azeem Latib, Federico De Marco, Marco De Carlo, Claudia Fiorina, Rocco Montone, Mauro Agnifili, Marco Barbanti, Anna Sonia Petronio, Giuseppe Biondi Zoccai, Federica Ettori, Silvio Klugmann, Corrado Tamburino, Nedy Brambilla, Antonio Colombo, Francesco Bedogni

Research output: Contribution to journalArticle

Abstract

Background - 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. Methods and Results - A total of 990 consecutive patients were enrolled in 6 high-volume centers and analyzed as follows: group 1, systolic pulmonary artery pressure (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. Conclusions - 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.

Original languageEnglish
Article numbere003563
JournalCirculation: Cardiovascular Interventions
Volume9
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

    Fingerprint

Keywords

  • aortic valve stenosis
  • hypertension, pulmonary
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Testa, L., Latib, A., De Marco, F., De Carlo, M., Fiorina, C., Montone, R., Agnifili, M., Barbanti, M., Petronio, A. S., Zoccai, G. B., Ettori, F., Klugmann, S., Tamburino, C., Brambilla, N., Colombo, A., & Bedogni, F. (2016). Persistence of severe pulmonary hypertension after transcatheter aortic valve replacement: Incidence and prognostic impact. Circulation: Cardiovascular Interventions, 9(6), [e003563]. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003563