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Pulmonary hypertension frequent comorbidity in patients with aortic stenosis undergoing TAVR
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The presence of pulmonary hypertension may independently predict poor short- and long-term outcomes after transcatheter aortic valve replacement in patients with severe aortic stenosis, researchers reported in The American Journal of Cardiology.
The study was conducted to evaluate the prevalence of pulmonary hypertension in this population and the long-term effects on pulmonary artery hemodynamics after TAVR. Researchers studied 415 consecutive patients with severe aortic stenosis (mean age, 84 years; 47% men; mean STS risk score, 10; mean logistic EuroSCORE, 30). All patients underwent TAVR with the Sapien or Sapien XT heart valves (Edwards Lifesciences) or the CoreValve (Medtronic) from 2007 to 2013 at MedStar Washington Hospital Center in Washington, D.C.
At baseline, 172 patients had no or mild pulmonary hypertension (systolic pulmonary artery pressure [SPAP] ≤ 50 mm Hg) compared with 243 patients who had moderate to severe pulmonary hypertension (SPAP > 50 mm Hg). Both groups had similar demographics, comorbidities, procedural characteristics and complications, but patients with moderate/severe pulmonary hypertension more frequently had right heart failure (35% vs. 19.8%; P = .02) and mitral regurgitation (18.4% vs. 8.6%; P = .007).
The researchers reported an early overall increase in SPAP after TAVR; however, only 26% of patients with moderate/severe pulmonary hypertension experienced a significant decrease in post-procedure SPAP greater than 10 mm Hg. “Interestingly, the decrease in SPAP occurred early, during the index hospitalization, and was maintained up to 1-year follow-up. However, SPAP values remained higher than the SPAP values among the patients in the no/mild pulmonary hypertension group throughout follow-up and did not return at any stage to normal values,” Israel M. Barbash, MD, from MedStar Washington Hospital Center, and colleagues wrote.
Compared with patients with no/mild pulmonary hypertension, those with moderate/severe pulmonary hypertension had increased mortality in the hospital (13.5% vs. 7%; P = .03), at 30 days (14.5% vs. 7.4%; P = .02) and at 1 year (30.8% vs. 21%; P = .02).
From baseline to 1 year, the prevalence of moderate/severe right ventricular dysfunction decreased from 35% to 18%, mitral regurgitation decreased from 18.4% to 6.2% and moderate/severe tricuspid regurgitation decreased from 23% to 9.1%.
In univariate analyses, STS score and moderate/severe lung disease were associated with poor outcome at 1 year among patients with moderate/severe pulmonary hypertension. In multivariable analyses, baseline SPAP and moderate/severe lung disease independently predicted poor outcome in this population.
“… A large amount of patients have concomitant pulmonary hypertension. This study shows that overall SPAP decreases after TAVR but does not normalize. Finally, similar to cardiac surgery, the presence of pulmonary hypertension is indeed an independent predictor of poor short- and long-term outcome after TAVR; however, by itself, it has low power to predict poor outcome as indicated by the intermediate sensitivity and specificity,” the researchers wrote. – by Rob Volansky
Disclosure: Barbash reported no relevant financial disclosures.
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