Abstract 18892: Clinical and Hemodynamic Factors Influence the Risk of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the PARTNER I Trial and Registry
Introduction: Pulmonary hypertension (PH) is associated with increased mortality after surgical or transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS).
Hypothesis: We hypothesized that clinical or hemodynamic factors might influence the relationship between significant PH and increased mortality.
Methods: Among patients with symptomatic AS at high or prohibitive surgical risk receiving TAVR in the PARTNER I randomized trial or registry, 2180 patients with an invasive measurement of mean pulmonary artery pressure (mPAP) recorded were included. PH was defined as: none (mPAP<25 mmHg), mild (25 to <35), and mod/sev (≥35).
Results: One year all-cause mortality was worse with increasing severity of PH: none (n=785, 18.6%), mild (n=838, 22.7%), and mod/sev (n=557, 25.0%) (p=0.01). The association between mod/sev PH (vs. no PH) and 1y mortality varied by sex and renal function (interaction p=0.03 and p=0.06, respectively). In females, mod/sev PH was associated with increased mortality (24.6% vs. 14.1%, HR 1.89, 95% CI 1.32-2.73); in males it was not (24.9% vs. 22.2%, HR 1.12, 95% CI 0.82-1.52). Additionally, mod/sev PH was associated with mortality in those with glomerular filtration rate (GFR) <40 (HR 1.76, 95% CI 1.28-2.42), but not in those with GFR ≥40. In a multivariable Cox PH model of patients with mod/sev PH, oxygen dependent lung disease, cerebrovascular disease, lower GFR, and lower baseline transvalvular mean gradient were each independently associated with increased 1y mortality (p<0.05 for all), whereas pulmonary artery compliance was the only hemodynamic variable associated with mortality (p=0.043) (Table).
Conclusions: The relationship between mod/sev PH and increased mortality after TAVR is altered by sex and renal function. While lower pulmonary artery compliance is associated with increased mortality in patients with significant PH, clinical factors appear to be more influential in stratifying risk than hemodynamic indices.
Author Disclosures: B.R. Lindman: Consultant/Advisory Board; Modest; Roche Diagnostics. Research Grant; Significant; Young Investigator Award from Gilead. Other Research Support; Significant; Assay support from Roche Diagnostics and BG-Medicine. A. Zajarias: Consultant/Advisory Board; Modest; Edwards Lifesciences. H. Maniar: None. R.M. Suri: Consultant/Advisory Board; Modest; Steering Committee: PORTICO Trial (St. Jude Medical), Edwards Lifesciences. Other; Modest; National PI: PERCEVAL Study (Sorin Medical). Other; Significant; Institutional Research Support from Edwards Lifesciences, St. Jude Medical and Sorin Medical. D. Miller: Research Grant; Significant; NHLBI #HL67025 (R01 Grant). Consultant/Advisory Board; Modest; Abbott Vascular, St. Jude Medical, Medtronic. Other; Modest; PARTNER Trial Executive Committee. J. Webb: Consultant/Advisory Board; Modest; Edwards Lifesciences. L.G. Svensson: Other; Modest; PARTNER Trial Executive Committee, Equity: Cardiosolutions, Equity: ValvExchange, Intellectual Property: PostThorax. K. Xu: None. F. Lin: None. S. Wong: None. V. Babaliaros: Consultant/Advisory Board; Modest; Direct Flow Medical. V.H. Thourani: Consultant/Advisory Board; Modest; Edwards Lifesciences, Sorin Medical, St, Jude Medical, DirectFlow. P.S. Douglas: None. S. Lim: Consultant/Advisory Board; Modest; Boston Scientific, Guerbet, St. Jude. M.B. Leon: Other; Modest; PARTNER Trial Executive Committee. M.J. Mack: Other; Modest; PARTNER Trial Executive Committee.
- © 2014 by American Heart Association, Inc.