Decoupling Between Pulmonary Artery Diastolic and Wedge Pressure Following TAVR

Abstract

<h3>Purpose</h3> Coexistent pulmonary hypertension with severe aortic stenosis confers a greater risk of mortality in undergoing TAVR. In this patient population, the impact of significant decoupling between pulmonary artery diastolic and pulmonary capillary wedge as it relates to clinical risk remained uncertain. <h3>Methods</h3> Patients with severe aortic stenosis who underwent TAVR and completed pre-procedural and post-procedural invasive hemodynamic assessments with right heart catheterization were retrospectively assessed. The impact of post-TAVR decoupling, defined as pressure difference ≥3 mmHg, on 2-year all-cause mortality or risk of heart failure admission was analyzed. <h3>Results</h3> Among 77 included patients (median 86 years old, 23 men), 16 had post-TAVR decoupling. The existence of post-TAVR decoupling was associated with a higher cumulative incidence of the primary endpoint (44% versus 7%, p = 0.001) with an adjusted hazard ratio of 5.87 (95% confidence interval 1.58-21.9, p = 0.008; Figure 1). <h3>Conclusion</h3> We observed a greater risk of worse outcomes in those with post-TAVR decoupling. Therapeutic strategy for the post-TAVR decoupling and its clinical implication remain the future concern.