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You are here: Contents > 2018 > Volume 27 Number 2 March 2018 > AORTIC VALVE DISEASE > Reversibility of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Implantation

Reversibility of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Implantation

Shabnam Rashid1,3, Jessica Fox2, Sabrina Kaur2, Matthew Kang2, Dominik Schlosshan2, Daniel Blackman2, Christopher Malkin2

1Bradford Royal Infirmary, Bradford, UK
2Leeds General Infirmary, Leeds, UK
3Electronic correspondence: shabnamrashid@doctors.org.uk

Background and aim of the study: To assess the prevalence and reversibility of pulmonary hypertension (PH) in patients undergoing Trans-catheter Aortic Valve implantation (TAVI) in a continuous unselected real-world cohort. Pulmonary hypertension is common in patients with severe aortic stenosis undergoing intervention, and is associated with worse outcomes. Identifying predictors of PH and PH regression after valve replacement may influence risk stratification and patient selection.

Materials and methods: Retrospective analysis of 308 patients who underwent TAVI. Pulmonary artery systolic pressure (PASP) was calculated by transthoracic echocardiography. PH was diagnosed if PASP was ≥50mmHg. Simple correlation and stepwise regression analyses were used to determine predictors of PH and the change in PASP after TAVI. Wilcoxon signed-rank Z-test was used to analyse ordinal data.

Results: 71 (24%) patients had PH, of whom 63 had echocardiographic follow up data and formed the study cohort. Mean PASP prior to TAVI was 62 ± 7 mmHg and reduced by a mean of 13 mmHg post TAVI in 52 (83%) patients (p <0.001). PH was reversed (PASP <50 mmHg) in 35 (56%) patients. Baseline PASP correlated with severity of mitral regurgitation (MR) (rS = 0.276, p = 0.03). Severity of MR (Z = -3.5, p <0.01) and left ventricular function (Z = -1.9, p = 0.06) also improved following TAVI. Reduction in PASP correlated with reduction in left ventricular end diastolic pressure (LVEDP) (rS = 0.4, p <0.003).

Conclusion: PH is common in patients undergoing TAVI, and in the majority is reversible. The only predictor of regression of PH is reduction in LVEDP at implantation.

The Journal of Heart Valve Disease 2018;27:135-140


Reversibility of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Implantation

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