Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement

ObjectivesTo determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality.MethodsConsecutive patients who underwent TAVR from July 2011 through January 2016 were studi...

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Vydáno v:Heart (British Cardiac Society) Ročník 104; číslo 10; s. 821 - 827
Hlavní autoři: Masri, Ahmad, Abdelkarim, Islam, Sharbaugh, Michael S, Althouse, Andrew D, Xu, Jeffrey, Han, Wei, Chan, Stephen Y, Katz, William E, Crock, Frederick W, Harinstein, Matthew E, Kliner, Dustin E, Navid, Forozan, Lee, Joon S, Gleason, Thomas G, Schindler, John T, Cavalcante, João L
Médium: Journal Article
Jazyk:angličtina
Vydáno: England BMJ Publishing Group LTD 01.05.2018
Témata:
Aged
Aged, 80 and over
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - surgery
Cardiology
Echocardiography, Doppler - methods
Female
Heart
Humans
Hypertension, Pulmonary - diagnosis
Hypertension, Pulmonary - epidemiology
Hypertension, Pulmonary - etiology
Kaplan-Meier Estimate
Male
Medical diagnosis
Mortality
Outcome Assessment, Health Care
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Prevalence
Pulmonary arteries
Pulmonary hypertension
Retrospective Studies
Social security
Society
Studies
Task forces
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - methods
Transcatheter Aortic Valve Replacement - mortality
United States - epidemiology
Veins & arteries
United States
pulmonary vascular disease
transcatheter valve interventions
aortic stenosis
ISSN:1355-6037, 1468-201X, 1468-201X
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Shrnutí:ObjectivesTo determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality.MethodsConsecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders.ResultsOf the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index.ConclusionsPersistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1355-6037
1468-201X
1468-201X
DOI:10.1136/heartjnl-2017-311978