Markus Reinthaler1, Barbara E. Stähli2, Aerkondal B. Gopalamurugan1, Philip Y. Xiu1, Suneil K. Aggarwal1, Georg Fröhlich1, Nicola Delahunty1, Michael J. Mullen1
1University College London Hospitals, The Heart Hospital Department of Cardiology, London, UK, 2Department of Cardiology University Hospital, Zürich, Switzerland
Background and aim of the study: Persistent arterial hypertension (HT) has been associated with increased morbidity and mortality after surgical aortic valve replacement (AVR). The impact of increased blood pressure (BP) after transcatheter aortic valve implantation (TAVI) has not yet been fully elucidated.
Methods: The mean systolic and diastolic BP after TAVI were calculated from the last 10 non-invasive recordings performed before discharge in 176 patients. The primary end-point was symptomatic improvement after 6-12 months according to BP control at the time of discharge.
Results: In patients with controlled BP (<140/90 mmHg), the symptomatic response after TAVI was significantly better compared to patients with uncontrolled BP (≥140/90 mmHg), as reflected by NYHA functional class (+1.4 ± 0.8 versus +0.8 ± 1.0, p = 0.002) and
six-minute walk test (6-MWT) distance improvement (+100 ± 71m versus +30 ± 64 m, p <0.001) at 6-12 months’ follow up. A 10 mmHg decrease in systolic BP was associated with an 18 m increase in 6-MWT distance (p = 0.001). In addition, reverse left ventricular (LV) remodeling was significantly impaired in uncontrolled BP individuals, as reflected by regression of LV mass (-15 ± 61 g versus -37 ± 54 g, p = 0.041) and relative wall thickness (-0.02 ± 0.09 versus -0.07 ± 0.1, p = 0.01). Cumulative all-cause and cardiovascular mortality were significantly lower in patients with controlled BP compared to those with uncontrolled BP (6.5% versus 16%, p = 0.04; cardiovascular 3.7% versus 11.6%, p = 0.035).
Conclusion: Uncontrolled HT after TAVI may contribute to diminished symptomatic improvement.
The Journal of Heart Valve Disease 2014;23:675-682
|Post-Procedural Arterial Hypertension: Implications for Clinical Outcome after Transcatheter Aortic Valve Implantation|
Click the above hyperlink to view the article, right click (Ctrl click on a Mac) to open in a new browser window or tab.
Please click the button below to purchase this article. Single article purchases are provided at $50.00 per article. Upon clicking the button below, single article user account subscription details are requested and, upon successful payment, a single article user account is created. Single articles are availble in your account for seven days after purchase.