Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

DOI Web Site 被引用文献3件
  • 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.).

書誌事項

タイトル別名
  • Insights From the New Proposed Pulmonary Hypertension Classification

説明

<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>

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