Persistent pulmonary hypertension may be predictive of mortality after TAVI

20170103100500, Pearl Toh
Persistent pulmonary hypertension predictive of mortality after TAVI

Persistence of pulmonary hypertension (PHT) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) was associated with a higher risk of death after the procedure, according to a study presented at the EuroEcho-Imaging 2016 Annual Meeting held recently in Leipzig, Germany.

“Limited amount of data suggest that patients undergoing TAVI with PHT experience [a] decrease in pulmonary artery systolic pressure,” according to the researchers. “[But] controversy still remains concerning the impact of persistent PHT on the prognosis of these patients.”

Following TAVI, all patients in the study experienced a reduction in mean pulmonary artery systolic pressure (43.8±12.3 vs 41.2±9.3 mm Hg; p<0.01). [EuroEcho-Imaging 2016, abstract P976]

Among the 174 patients (mean age 80 years) analysed, a total of 42 patients (23.6 percent) were dead during a follow-up duration of 24.8 months. Patients who did not survive at the end of the follow-up period had a higher mean systolic pulmonary pressure following TAVI than those who survived (43.4±7.6 vs 40.4±9.7 mm Hg; p=0.04).

Also, patients with persistent PHT had a higher mortality rate than those with normal PHT after the procedure (37 percent vs 10.8 percent; p<0.01).

“The early reduction of systolic pulmonary pressure after TAVI is associated with reduced cumulative mortality,” said resident cardiologist Dr Archontoula Michelongona of Tzaneio General Hospital of Piraeus in Greece, who presented the study.

Multivariate regression analysis showed that persistent PHT independently predicted cumulative mortality, with the odds of mortality more than tripled for those with persistent PHT (odds ratio, 3.269, 95 percent confidence interval, 1.322–8.044; p=0.01).

The prospective study enrolled patients with severe, symptomatic AS who had been scheduled for TAVI. Echocardiographic imaging was performed in all participants before and after TAVI. Pulmonary artery systolic pressure was based on “the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure.” PHT of <35mmHg following TAVI was considered normal and that =35mmHg as persistent.