Abstract 18874: Prognostic Importance of Pulmonary Hypertension Etiology by Invasive Hemodynamics in Patients With Severe Aortic Stenosis
Introduction: Pulmonary hypertension (PH) may arise from both pre-capillary and post-capillary etiologies which can be evaluated and quantified by invasive hemodynamics (CATH). The impact of PH etiology on all-cause mortality of patients with severe aortic stenosis (AS) is unknown.
Hypothesis: CATH classification of PH etiology allows for identification of severe AS patients with combined pre and post-capillary PH that would have the highest mortality risk.
Methods: Retrospective data collection of patients with severe AS (AV area index ≤ 0.6 cm2/m2) and CATH with invasive hemodynamics was performed. Patients were classified as having: a) no PH (PAmean<25mmHg), b) pre-capillary PH (PAH, PAmean≥25mmHg and pulmonary capillary wedge pressure, PCWP15mmHg). Multivariate Cox-proportional hazard model was used for risk-adjustment comparisons.
Results: A total of 187 patients were identified with mean age of 77 ± 10 years, 62% male and 38% diabetic. After a median follow-up of 18 months (IQR: 5-27 months), there were 66 deaths (35%). According to the etiology, 54 patients (29%) had no PH, 18 (10%) had PAH, 78 (42%) had passive PH, and 37 (20%) had combined PH. After adjustments for AVR (HR=0.14, 95% CI 0.05-0.35,p<0.01), age, gender, BMI, diabetes, and NYHA class, presence of combined PH by CATH was independently associated with increased risk (HR vs. no PH=2.49, 95% CI 1.09- 5.73, P=0.03). (Figure 1)
Conclusion: Post-capillary PH is very common in severe AS (62%). Ascertainment of PH etiology by CATH is important as combined pre-post capillary PH is associated with increased short-term mortality despite adjustments for AVR and other comorbidities. Whether this risk can be decreased by further interventions needs to be investigated in future studies.
Author Disclosures: J.L. Cavalcante: Research Grant; Modest; Medtronic. A. Althouse: None. R. Campbell-Massa: None. M. Maddula: None. T.G. Gleason: Research Grant; Modest; Medtronic. W. Katz: None. F. Crock: None. M. Harinstein: None. F. Navid: None. D. Kliner: None. J.T. Schindler: None. J.S. Lee: None.
- © 2015 by American Heart Association, Inc.