Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From the New Proposed Pulmonary Hypertension Classification.

O'Sullivan, Crochan John; Wenaweser, Peter Martin; Ceylan, Osman Ernst; Rat-Wirtzler, Julie; Stortecky, Stefan; Heg, Dik; Spitzer, Ernest; Zanchin, Thomas; Praz, Fabien; Tüller, David; Huber, Christoph; Pilgrim, Thomas; Nietlispach, Fabian; Khattab, Ahmed Aziz; Carrel, Thierry; Meier, Bernhard; Windecker, Stephan; Büllesfeld, Lutz (2015). Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From the New Proposed Pulmonary Hypertension Classification. Circulation: Cardiovascular interventions, 8(7), e002358. Lippincott Williams & Wilkins 10.1161/CIRCINTERVENTIONS.114.002358

[img]
Preview
Text
O'Sullivan CircCardiovascInterv 2015_e002358.pdf - Published Version
Available under License Publisher holds Copyright.

Download (1MB) | Preview

BACKGROUND Pulmonary hypertension (PH) frequently coexists with severe aortic stenosis, and PH severity has been shown to predict outcomes after transcatheter aortic valve implantation (TAVI). The effect of PH hemodynamic presentation on clinical outcomes after TAVI is unknown. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 433 (71.4%) patients with severe aortic stenosis and a preprocedural right heart catheterization were assessed. Patients were dichotomized according to whether PH was present (mean pulmonary artery pressure, ≥25 mm Hg; n=325) or not (n=108). Patients with PH were further dichotomized by left ventricular end-diastolic pressure into postcapillary (left ventricular end-diastolic pressure, >15 mm Hg; n=269) and precapillary groups (left ventricular end-diastolic pressure, ≤15 mm Hg; n=56). Finally, patients with postcapillary PH were divided into isolated (n=220) and combined (n=49) subgroups according to whether the diastolic pressure difference (diastolic pulmonary artery pressure-left ventricular end-diastolic pressure) was normal (<7 mm Hg) or elevated (≥7 mm Hg). Primary end point was mortality at 1 year. PH was present in 325 of 433 (75%) patients and was predominantly postcapillary (n=269/325; 82%). Compared with baseline, systolic pulmonary artery pressure immediately improved after TAVI in patients with postcapillary combined (57.8±14.1 versus 50.4±17.3 mm Hg; P=0.015) but not in those with precapillary (49.0±12.6 versus 51.6±14.3; P=0.36). When compared with no PH, a higher 1-year mortality rate was observed in both precapillary (hazard ratio, 2.30; 95% confidence interval, 1.02-5.22; P=0.046) and combined (hazard ratio, 3.15; 95% confidence interval, 1.43-6.93; P=0.004) but not isolated PH patients (P=0.11). After adjustment, combined PH remained a strong predictor of 1-year mortality after TAVI (hazard ratio, 3.28; P=0.005). CONCLUSIONS Invasive stratification of PH according to hemodynamic presentation predicts acute response to treatment and 1-year mortality after TAVI.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
?? E58F698552B40152E0405C82960C10AF ??
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
?? 08ED1761AB992B87E053960C5C823EEA ??

UniBE Contributor:

O'Sullivan, Crochan John; Wenaweser, Peter Martin; Ceylan, Osman Ernst; Rat, Julie; Stortecky, Stefan; Heg, Dierik Hans; Praz, Fabien; Huber, Christoph; Pilgrim, Thomas; Nietlispach, Fabian; Khattab, Ahmed Aziz; Carrel, Thierry; Meier, Bernhard; Windecker, Stephan and Büllesfeld, Lutz

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1941-7632

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

05 Aug 2015 14:38

Last Modified:

11 Sep 2017 18:39

Publisher DOI:

10.1161/CIRCINTERVENTIONS.114.002358

PubMed ID:

26156149

Uncontrolled Keywords:

aortic valve catheterization hemodynamics hypertension hypertension, pulmonary

BORIS DOI:

10.7892/boris.70715

URI:

https://boris.unibe.ch/id/eprint/70715

Actions (login required)

Edit item Edit item
Provide Feedback