Abstract 17015: Prognostic Value of Elevated Pulmonary Artery Pressure in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
We retrospectively evaluated pulmonary artery pressure (PAP), clinical and echo-Doppler parameters to predict 1year mortality in 211 patients (pts) enrolled in PARTNER trial at single US center.
Age was 86±7 years, 58% male, NYHA 3.6±0.5, aortic valve area (AVA) 0.8±0.4, Vmax 4.2±0.8, mean AV pressure gradient (MPG) 47±32, LV ejection fraction (LVEF) 56±16, and PAP 45±16. Pts with PAP ≥50mmHg (n=81) vs. PAP<50mmHg (n=130) had higher filling pressure, worst CHF, and STS scores (Table). Of pts with PAP ≥50: 59% had transfemoral (TF) transcatheter aortic valve replacement (TAVR), 17% had transapical (TA) TAVR and 24% had surgical aortic valve replacement (SAVR); and for PAP <50: 61% had TF-TAVR, 16% had TA-TAVR and 23% had SAVR (p=0.952). Pts with PAP ≥50 vs. PAP <50 had higher 1 year mortality: 46% vs. 24% in TAVR group (p=0.003), and 36% vs. 17% in SAVR group (p=0.136) (Figure); and 47% vs. 13% in pts with STS ≤10, and 42% vs. 26% in pts with STS >10 (p=0.003). Univariate predictors of 1 year mortality were: male gender, fraility, smoking, prior MI, creatinine >2, cirrhosis, bilirubin, hemoglobin, BNP >400, PAP ≥50, central venous pressure >10, LV end systolic size, baseline MR >moderate; and post procedural improvement in NYHA (Table). In Cox regression analysis significant predictors of 1 year mortality were: PAP >50 (HR 16, CI 3-83, p=0.001), failure to improve NYHA ≥1 (HR 12, CI 1.9-72, p=0.008) and male gender (HR 8, CI 1.7-36, p=0.009).
Elevated PAP, male gender, and failure to improve NYHA class ≥1 after procedure were independent predictors of 1 year mortality after AVR especially after TAVR. More studies are needed to evaluate specific therapies for optimizing PAP on TAVR outcomes.
- © 2012 by American Heart Association, Inc.