A 10 mmHg decrease in transtricuspid pressure gradient after TAVI was associated with a reduced risk of cardiovascular death and heart failure hospitalization (HR 0.76; 95% CI 0.64-0.90; p=0.0020).
Observational (n=2,056)
Yes
Does the recovery of pulmonary hypertension after TAVI reduce the composite of cardiovascular death and heart failure hospitalization in patients with aortic stenosis?
Recovery of pulmonary hypertension after TAVI is associated with a significantly reduced risk of cardiovascular death and heart failure hospitalization.
Effect estimate: HR 0.76 (95% CI 0.64-0.90)
p-value: p=0.0020
Pulmonary hypertension (PH) is a common complication of aortic stenosis (AS). Despite the established association between PH and poor outcomes in patients with AS, the prognostic implication of a change in PH after transcatheter aortic valve implantation (TAVI) has been rarely evaluated. This study analyzed a prospective multi-center TAVI registry database involving six Japanese centers and used the transtricuspid pressure gradient (TRPG) obtained by echocardiography to estimate pulmonary artery systolic pressure. The participants (n = 2056) were first divided into two groups by TRPG before TAVI, a PH (−) group (TRPG < 30 mmHg) (n = 1407, 61.9%) and a PH (+) group (TRPG ≥ 30 mmHg) (n = 649, 28.6%). Next, by TRPG after (4.1 ± 5.3 days) TAVI, the PH (+) group was further subdivided into two groups, Recovered PH (TRPG < 30 mmHg, n = 253) and Persistent PH (TRPG after TAVI ≥ 30 mmHg, n = 396). The median follow-up duration was 1.8 years. The primary and secondary endpoints were the composite and each of cardiovascular (CV) death and heart failure hospitalization, respectively. Unadjusted Kaplan-Meier estimates with log-rank comparisons showed significantly higher cumulative incidences of primary and secondary endpoints in the Persistent PH group compared to other groups. Moreover, adjusted multivariate Cox-proportional hazard analyses showed that a decreased (−10 mmHg) TRPG after TAVI was linearly associated with a reduced risk of the primary endpoint (hazard ratio (HR): 0.76, 95% confidence interval (CI): 0.64−0.90, p = 0.0020). The findings in the present study indicate that the recovery of PH may partly contributes to the prognostic benefit of TAVI procedure in patients with AS and elevated pulmonary artery systolic pressure.
Koike et al. (Mon,) conducted a observational in Aortic stenosis with pulmonary hypertension (n=2,056). Decreased TRPG (-10 mmHg) after TAVI vs. Persistent pulmonary hypertension was evaluated on Composite of cardiovascular death and heart failure hospitalization (HR 0.76, 95% CI 0.64-0.90, p=0.0020). A 10 mmHg decrease in transtricuspid pressure gradient after TAVI was associated with a reduced risk of cardiovascular death and heart failure hospitalization (HR 0.76; 95% CI 0.64-0.90; p=0.0020).