RT Journal Article
SR Electronic
T1 Risk stratification in patients with pulmonary hypertension undergoing transcatheter aortic valve replacement
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1656
OP 1664
DO 10.1136/heartjnl-2015-308001
VO 101
IS 20
A1 Brian R Lindman
A1 Alan Zajarias
A1 Hersh S Maniar
A1 D Craig Miller
A1 Rakesh M Suri
A1 Suzanne V Arnold
A1 John Webb
A1 Lars G Svensson
A1 Susheel Kodali
A1 Ke Xu
A1 Girma M Ayele
A1 Fay Lin
A1 Shing-Chiu Wong
A1 Vasilis Babaliaros
A1 Vinod H Thourani
A1 Pamela S Douglas
A1 Scott Lim
A1 Martin B Leon
A1 Michael J Mack
YR 2015
UL http://heart.bmj.com/content/101/20/1656.abstract
AB Objective Pulmonary hypertension (PH) is associated with increased mortality after surgical or transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS), and when the pulmonary artery pressure is particularly elevated, there may be questions about the clinical benefit of TAVR. We aimed to identify clinical and haemodynamic factors associated with increased mortality after TAVR among those with moderate/severe PH.Methods Among patients with symptomatic AS at high or prohibitive surgical risk receiving TAVR in the Placement of Aortic Transcatheter Valves (PARTNER) I randomised trial or registry, 2180 patients with an invasive measurement of mean pulmonary artery pressure (mPAP) recorded were included, and moderate/severe PH was defined as an mPAP ≥35 mm Hg.Results Increasing severity of PH was associated with progressively worse 1-year all-cause mortality: none (n=785, 18.6%), mild (n=838, 22.7%) and moderate/severe (n=557, 25.0%) (p=0.01). The increased hazard of mortality associated with moderate/severe PH was observed in females, but not males (interaction p=0.03). In adjusted analyses, females with moderate/severe PH had an increased hazard of death at 1 year compared with females without PH (adjusted HR 2.14, 95% CI 1.44 to 3.18), whereas those with mild PH did not. Among males, there was no increased hazard of death associated with any severity of PH. In a multivariable Cox model of patients with moderate/severe PH, oxygen-dependent lung disease, inability to perform a 6 min walk, impaired renal function and lower aortic valve mean gradient were independently associated with increased 1-year mortality (p<0.05 for all), whereas several haemodynamic indices were not. A risk score, including these factors, was able to identify patients with a 15% vs 59% 1-year mortality.Conclusions The relationship between moderate/severe PH and increased mortality after TAVR is altered by sex, and clinical factors appear to be more influential in stratifying risk than haemodynamic indices. These findings may have implications for the evaluation of and treatment decisions for patients referred for TAVR with significant PH.Trial registration NCT00530894.