Abstract 16640: Prognostic Importance of Pulmonary Hypertension Severity by Invasive Hemodynamics in Patients With Severe Aortic Stenosis

Abstract

Introduction: The prevalence and impact of pulmonary hypertension (PH) severity on clinical outcomes for patients with severe AS is unclear and controversial. Our goal was to compare the correlation of mortality to degree of PH as measured by transthoracic echocardiography (ECHO) versus invasive hemodynamics (CATH). Methods: Retrospective data collection of patients with severe aortic stenosis (AV area index ≤ 0.6 cm2/m2) and measured pulmonary artery systolic pressure (PASP) by ECHO and CATH within 60 days of one another from 2010-2014. According to guidelines, patients were classified as having no PH (PASP<35mmHg), mild PH (PASP 35-45mmHg), moderate PH (PASP 46-59mmHg), and severe PH (PASP≥60mmHg) by each method. Multivariate Cox-proportional hazard model was used for risk-adjustment comparisons. Results: A total of 186 patients were identified with mean age of 77 ± 10 years, 62% male and 38% diabetic. The median time difference between the 2 procedures was 4 days (IQR: 1-13 days). After a median follow-up of 18 months (IQR: 5-27 months), there were 63 deaths (34%). Moderate/Severe PH was prevalent by either ECHO or CATH (47% vs. 62%, p<0.0001, respectively) although with modest agreement between ECHO and CATH PH severity (kappa=0.37). Both PH severity assessments were strongly associated with mortality; however, CATH showed better stratification with moderate PH associated with equally significant mortality risk (Figure 1). After adjustment for AVR (HR=0.23, 95% CI 0.11-0.48,p<0.01), age, gender, BMI, diabetes, and NYHA class, presence of moderate PH by CATH remained associated increased mortality risk (HR=2.25, 95% CI 1.04-4.89, p=0.04). Conclusions: Moderate or greater PH is common among severe AS patients and is more commonly diagnosed by CATH. Ascertainment of PH severity by CATH is important as even moderate PH correlates with increased 1-yr mortality despite adjustment for AVR and other comorbidities.