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  4. Prognostic Implications of the Novel Pulmonary Hypertension Definition in Patients with Aortic Stenosis after Transcatheter Valve Replacement
 
research article

Prognostic Implications of the Novel Pulmonary Hypertension Definition in Patients with Aortic Stenosis after Transcatheter Valve Replacement

Adamopoulos, Dionysios
•
Pagoulatou, Stamatia  
•
Rovas, Georgios  
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August 1, 2022
Journal Of Clinical Medicine

Introduction: Pulmonary hypertension (PH), traditionally defined as a mean pulmonary artery pressure (PAP) >= 25 mmHg, is associated with poor outcomes in patients undergoing a transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Recently, a novel definition for PH has been proposed, placing the cut-off value of mean PAP at 20 mmHg, and introducing pulmonary vascular resistance as an exclusive indicator for the pre-capillary involvement. In light of the novel criteria, whether PH still preserves its prognostic significance remains unknown. Methods: The study population consisted of 380 patients with AS, who underwent a right heart catheterization before TAVR. The cohort was divided according to the presence of PH (n = 174, 45.7%) or not. Patients with PH were further divided into the following groups: (1) Pre-capillary PH ((Pre-capPH), n = 46, 12.1%); (2) Isolated post-capillary PH ((IpcPH), n = 78, 20.5%); (3) Combined pre and post-capillary PH ((CpcPH), n = 82, 21.6%). The primary endpoint was all-cause mortality at 1 year. Results: A total of 246 patients (64.7%) exhibited mean PAP > 20 mmHg. Overall, the presence of PH was associated with higher 1-year mortality rates (hazard ratio (HR) 2.8, 95% CI: 1.4-5.8, p = 0.004). Compared to patients with no PH, Pre-capPH and CpcPH (but not IpcPH) were related to higher 1-year mortality (HR 2.7, 95% CI: 1.0-7.2, p = 0.041 and HR 3.9, 95% CI: 1.8-8.5, p = 0.001, respectively). This remained significant even after the adjustment for baseline comorbidities. Conclusions: Pre-interventional PH according to the novel hemodynamic criteria, is linked with poor outcomes in patients undergoing TAVR for severe AS. However, this is mainly driven by patients with mean PAP >= 25 mmHg. Patients with a pre-capillary PH component as defined by increased PVR present an even worse prognosis as compared to patients with isolated post-capillary or no PH who present comparable 1-year mortality rates.

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Type
research article
DOI
10.3390/jcm11154279
Web of Science ID

WOS:000838865700001

Author(s)
Adamopoulos, Dionysios
Pagoulatou, Stamatia  
Rovas, Georgios  
Bikia, Vasiliki  
Mueller, Hajo
Giannakopoulos, Georgios
Mauler-Wittwer, Sarah
Licker, Marc-Joseph
Stergiopulos, Nikolaos  
Lador, Frederic
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Date Issued

2022-08-01

Publisher

MDPI

Published in
Journal Of Clinical Medicine
Volume

11

Issue

15

Article Number

4279

Subjects

Medicine, General & Internal

•

General & Internal Medicine

•

pulmonary hypertension

•

aortic stenosis

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transcatheter aortic valve replacement

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artery pressure

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impact

•

implantation

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risk

Editorial or Peer reviewed

REVIEWED

Written at

EPFL

EPFL units
LHTC  
Available on Infoscience
August 29, 2022
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/190341
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