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Impact of persistent pulmonary hypertension on patients with severe aortic valve stenosis following TAVI

Session Poster session 5

Speaker Konstantinos Toutouzas

Event : ESC Congress 2015

  • Topic : imaging
  • Sub-topic : Echocardiography: Systolic and Diastolic Function
  • Session type : Poster Session

Authors : M Drakopoulou (Athens,GR), K Toutouzas (Athens,GR), K Stathogiannis (Athens,GR), G Latsios (Athens,GR), A Synetos (Athens,GR), A Michelongona (Athens,GR), A Mastrokostopoulos (Athens,GR), G Trantalis (Athens,GR), O Kaitozis (Athens,GR), D Tousoulis (Athens,GR)

Authors:
M. Drakopoulou1 , K. Toutouzas1 , K. Stathogiannis1 , G. Latsios1 , A. Synetos1 , A. Michelongona1 , A. Mastrokostopoulos1 , G. Trantalis1 , O. Kaitozis1 , D. Tousoulis1 , 1Hippokration Hospital, University of Athens, 1st Department of Cardiology - Athens - Greece ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 838

Background: Severe aortic stenosis leads to augmented afterload, changes in cardiac function and often increased systolic pulmonary arterial pressure. The persistence of these changes after surgical aortic valve replacement has been linked to unfavorable outcome. There is a controversy regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI).

Purpose: We sought to investigate the impact of persistent PHT on 3-year all-cause mortality of patients with severe aortic stenosis following 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 prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Systolic pulmonary artery pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT flowing TAVI was classified as absent if <35mmHg and persistent if ≥35mmHg. Primary clinical end-point was all 3-year all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2 criteria.

Results: Hundred and thirty-three patients (mean age: 80±7 years) were included in the study. The primary clinical end point occurred in 22 patients (17%) during a median follow-up period of 3 years. Mean systolic pulmonary artery pressure was reduced in all patients following TAVI (43±11 versus 40±8mmHg, p<0.001). Mortality rate was higher in patients with persistent PHT compared to patients with normal systolic pulmonary artery pressure following TAVI (32% versus 10%, p<0.002). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (44±8 versus 40±8mmHg, p=0.02). In multivariate regression analysis, persistence of PHT (OR: 3.310, 95% CI: 1.182–9.224, p=0.02) and logEuroSCORE (OR: 1.051, 95% CI: 1.006–1.098, p<0.026) were independent predictors of mortality.

Conclusions: The persistence of pulmonary hypertension post TAVI is associated independently with long term mortality. Further investigation is warranted for the early identification of this population with severe aortic stenosis.

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