Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation
-
- Crochan J. O’Sullivan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Peter Wenaweser
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Osman Ceylan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Julie Rat-Wirtzler
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Stefan Stortecky
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Dik Heg
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Ernest Spitzer
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Thomas Zanchin
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Fabien Praz
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- David Tüller
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Christoph Huber
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Thomas Pilgrim
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Fabian Nietlispach
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Ahmed A. Khattab
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Thierry Carrel
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Bernhard Meier
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Stephan Windecker
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
-
- Lutz Buellesfeld
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
Bibliographic Information
- Other Title
-
- Insights From the New Proposed Pulmonary Hypertension Classification
Description
<jats:sec> <jats:title>Background—</jats:title> <jats:p>Pulmonary hypertension (PH) frequently coexists with severe aortic stenosis, and PH severity has been shown to predict outcomes after transcatheter aortic valve implantation (TAVI). The effect of PH hemodynamic presentation on clinical outcomes after TAVI is unknown.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> Of 606 consecutive patients undergoing TAVI, 433 (71.4%) patients with severe aortic stenosis and a preprocedural right heart catheterization were assessed. Patients were dichotomized according to whether PH was present (mean pulmonary artery pressure, ≥25 mm Hg; n=325) or not (n=108). Patients with PH were further dichotomized by left ventricular end-diastolic pressure into postcapillary (left ventricular end-diastolic pressure, >15 mm Hg; n=269) and precapillary groups (left ventricular end-diastolic pressure, ≤15 mm Hg; n=56). Finally, patients with postcapillary PH were divided into isolated (n=220) and combined (n=49) subgroups according to whether the diastolic pressure difference (diastolic pulmonary artery pressure−left ventricular end-diastolic pressure) was normal (<7 mm Hg) or elevated (≥7 mm Hg). Primary end point was mortality at 1 year. PH was present in 325 of 433 (75%) patients and was predominantly postcapillary (n=269/325; 82%). Compared with baseline, systolic pulmonary artery pressure immediately improved after TAVI in patients with postcapillary combined (57.8±14.1 versus 50.4±17.3 mm Hg; <jats:italic>P</jats:italic> =0.015) but not in those with precapillary (49.0±12.6 versus 51.6±14.3; <jats:italic>P</jats:italic> =0.36). When compared with no PH, a higher 1-year mortality rate was observed in both precapillary (hazard ratio, 2.30; 95% confidence interval, 1.02–5.22; <jats:italic>P</jats:italic> =0.046) and combined (hazard ratio, 3.15; 95% confidence interval, 1.43–6.93; <jats:italic>P</jats:italic> =0.004) but not isolated PH patients ( <jats:italic>P</jats:italic> =0.11). After adjustment, combined PH remained a strong predictor of 1-year mortality after TAVI (hazard ratio, 3.28; <jats:italic>P</jats:italic> =0.005). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Invasive stratification of PH according to hemodynamic presentation predicts acute response to treatment and 1-year mortality after TAVI.</jats:p> </jats:sec>
Journal
-
- Circulation: Cardiovascular Interventions
-
Circulation: Cardiovascular Interventions 8 (7), e002358-, 2015-07
Ovid Technologies (Wolters Kluwer Health)
- Tweet
Details 詳細情報について
-
- CRID
- 1362825894600829056
-
- ISSN
- 19417632
- 19417640
-
- Data Source
-
- Crossref