Author + information
- Received May 1, 2019
- Revision received August 15, 2019
- Accepted August 27, 2019
- Published online November 4, 2019.
- Jury Schewel, MD∗ (, )
- Tobias Schmidt, MD,
- Karl-Heinz Kuck, MD,
- Christian Frerker, MD and
- Dimitry Schewel, MD
- ↵∗Address for correspondence:
Dr. Jury Schewel, Marienkrankenhaus Hamburg, Department of Cardiology, Alfredstrasse 9, 22087 Hamburg, Germany.
Objectives The aim of this study was to investigate the prognostic impact and development of pulmonary hypertension (PH) in the different hemodynamic subtypes of PH in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Background PH is a frequent finding in patients with severe AS and predicts outcome after TAVR. Nevertheless, outcomes among PH subtypes and the impact of residual PH after TAVR are controversial.
Methods A total of 1,400 patients with symptomatic AS and full invasive hemodynamic assessment before and after TAVR were included. Patients were stratified into 4 groups: no PH (n = 658); isolated pre-capillary PH (n = 139), isolated post-capillary PH (Ipc-PH; n = 534), and combined post-capillary and pre-capillary PH (n = 69).
Results The mean overall patient age was 81.5 ± 6.8 years, and 46.3% were men. Acute device success was achieved in 94.9%. Patients without PH showed significantly lower mortality rates compared with patients with PH (1 year, 13.8% vs. 22.4% [p < 0.001]; 4 years, 37.2% vs. 51.5% [p < 0.001]). Patients with pre-capillary PH showed 1.9-fold increased 1-year mortality and those with Ipc-PH showed 1.5-fold increased 1-year mortality compared with patients without pH (p = 0.001). No differences regarding survival were found among the subgroups. Only in patients with Ipc-PH, residual PH was associated with 2.1-fold increased mortality (p = 0.010). All patients benefited in terms of functional capacity after TAVR.
Conclusions Patients with pre-capillary PH and those with Ipc-PH showed significantly higher risk for death after TAVR compared with those without PH. Reversible PH had no benefit for survival except in patients with Ipc-PH. Hemodynamic stratification of PH is helpful for risk and response prediction in patients with AS undergoing TAVR.
Dr. Frerker is a proctor for St. Jude Medical, Medtronic, and Boston Scientific; and has received lecture honoraria from Edwards Lifesciences. Dr. Schmidt has received lecture honoraria from Medtronic. Dr. Kuck has received consulting fees and honoraria from Biosense Webster, Medtronic, Boston Scientific, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 1, 2019.
- Revision received August 15, 2019.
- Accepted August 27, 2019.
- 2019 American College of Cardiology Foundation
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