Journal article
Prognostic role of pulmonary hemodynamics before transcatheter aortic valve replacement among patients with severe aortic stenosis
The Journal of heart and lung transplantation, v 42(2), pp 275-282
Feb 2023
PMID: 36437170
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Pulmonary hypertension (PH) frequently co-exists in patients with severe aortic stenosis (AS). In this study, we sought to identify the implications of invasive pulmonary hemodynamics on major adverse cardiac events (MACE), biventricular function and NYHA functional class after transcatheter aortic valve replacement (TAVR).
Invasive hemodynamics via right heart catheterization (RHC) were performed pre-TAVR. Patients were stratified per mean PA pressure (mPAP), diastolic pulmonary gradient (DPG) and pulmonary vascular resistance (PVR), and followed at 1-month and 1-year intervals up to 6 years. MACE outcomes included cardiovascular death and heart failure hospitalizations post-TAVR.
Among 215 patients, Kaplan-Meir estimates demonstrated an increased 1-year risk of MACE from 8% among those without pre-TAVR PH to 27% among patients with pre-existing PH. Specifically, the MACE risk was 32% among PH patients with PVR ≥ 3WU (p = .04) and 53% among PH patients with DPG ≥ 7 mm Hg (p < .01). On univariate Cox regression, RV stroke work index (RVSWI) (HR,1.02; p = .02), and pulmonary hemodynamic index (PHI) (HR,1.27; p = .047) were identified as additional predictors of MACE post-TAVR. On multivariable Cox regression analysis, SvO2 (HR, 0.95; p = .01) and PVR (HR, 1.2; p = .04) were demonstrated as predictive of MACE post-TAVR. A significant improvement in LVEF (2-Factor ANOVA, p < .01) and RV fractional area change (RVFAC%) (p < .01) was noted as assessed at baseline, 1-month and 1-year follow up post-TAVR. There was a significant interaction between pre-TAVR PH status and time post procedure with respect to NYHA functional class (p = .03), that is, the manner and degree of change in NYHA class over time depended on pre-TAVR PH status.
Defining invasive pulmonary hemodynamics, such as mPAP, PVR, and DPG among patients with severe AS undergoing TAVR has significant prognostic implications. Routine risk stratification by utilizing invasive hemodynamics can better identify patients who will have functional improvement and improved outcomes post-TAVR.
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Details
- Title
- Prognostic role of pulmonary hemodynamics before transcatheter aortic valve replacement among patients with severe aortic stenosis
- Creators
- Garima Dahiya - University of Minnesota Medical CenterAndreas Kyvernitakis - Allegheny Health NetworkAdee Elhamdani - Allegheny Health NetworkAndrew Begg - Allegheny Health NetworkMark Doyle - Allegheny Health NetworkMahmoud Elsayed - Allegheny Health NetworkStephen Bailey - Allegheny Health NetworkAmresh Raina - Allegheny Health NetworkManreet Kanwar - Allegheny Health NetworkRobert W.W. Biederman - Allegheny Health NetworkRaymond L. Benza - The Ohio State University Wexner Medical Center
- Publication Details
- The Journal of heart and lung transplantation, v 42(2), pp 275-282
- Publisher
- Elsevier
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiothoracic Surgery; Medicine (Graduate); Cardiology
- Web of Science ID
- WOS:000924588100001
- Scopus ID
- 2-s2.0-85143161822
- Other Identifier
- 991021932103304721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery
- Transplantation