0055 : Pulmonary hypertension and transcatheter aortic valve implantation: prevalence, prognosis impact and evolution

Abstract

In patients undergoing transcatheter aortic valve implantation, measurement of pulmonary pressure may help to stratify the clinical risk. However, data may lead to patient misclassification and the role of pulmonary vascular resistance which include cardiac output has never been investigated. One hundred and seventy one consecutive patients with significant symptomatic aortic stenosis (aortic valve area <1 cm2or 0.6 cm2m2 who prospectively were scheduled for transaortic valve implantation, underwent preoperative right-sided heart catheterization and quantitative Doppler echocardiography. Of these, 99 (57.9%) had pulmonary hypertension [invasive mean pulmonary artery pressure (PAP) ≥25mm Hg] and 40 experienced cardiac events during a 1-year follow-up (readmission for heart failure in 16 patients, sudden and non-cardiac death in 24). In univariate analysis, patients who had cardiac events exhibited a higher both peak systolic PAP (46.9±12.1 versus 40.8±12,0mm Hg; P=0.026) and transpulmonary pressure gradient (12.6±4.5 versus 10.1±3,7mm Hg; P=0.011), as well as increased pulmonary vascular resistance (PVR, 2.7±1.0 vs. 2.0±0.8 WU, p = 0.002). Peak systolic PAP>40mm Hg and PVR>2.05 WU were selected by receiver operating curve for predicting cardiac events with the best sensitivity and specificity. By multivariate Cox regression analysis, independent predictors of cardiac events were as follows: body mass index (P=0.005), a mitral regurgitation (P=0.018), and a spectrum of peak systolic PAP>40mm Hg with simultaneous PVR>2.05 WU compared with other patients [2.6 (1.39-4.89), p=0.003]. Right heart catheterization could be useful to identify a highrisk subset of aortic stenosis patients candidate for transcatheter aortic valve implantation and help for clinical decision making.