Author + information
- Maria I. Drakopoulou,
- Konstantinos Toutouzas,
- Archontoula Michelongona,
- Konstantinos Stathogiannis,
- George Latsios,
- Andreas Synetos,
- Styliani Brili,
- Odysseas Kaitozis,
- Eleftherios Tsiamis and
- Dimitris Tousoulis
Background: Severe aortic valve stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). The aim of our study was to elucidate the impact of persistent PHT on long-term all-cause mortality of patients with severe aortic stenosis undergoing TAVI.
Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1cm2), who were scheduled for TAVI with a self-expanding valve at our institution, were consecutively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure (PASP) was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was considered when PASP≥35mmHg. Primary clinical end-point was cumulative mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2.
Results: We included 176 patients (mean age: 81±7 years) in the study. The primary clinical end point occurred in 41 patients (23%) during a follow-up period of 26.8±20.7 months. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (43.2±11.4 versus 41.1±9.5mmHg, p=0.003). Mortality rate was higher in patients with persistent PHT compared to patients without PHT after TAVI (35% versus 19%, p<0.001). Stroke rates were similar (1% without PHT vs 2% in PHT, p=0.25) in both groups. In multivariate regression analysis, persistence of PHT (OR: 5.004, 95% CI: 2.153-11.632, p=0.001) was an independent predictor of cumulative mortality.
Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long-term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by further trials.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Innovative Use of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1197-221
- 2017 American College of Cardiology Foundation