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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is an established therapeutic option in patients with severe aortic valve stenosis (AS) and a high surgical risk profile. Pulmonary hypertension (PH)—often co-existing with severe AS—is associated with a limited factor for prognosis and survival. The purpose of this study was to evaluate the prevalence of PH in patients undergoing TAVI, classify these patients based on right heart catheter (RHC) measurements in different PH subtypes, and analyze prognostic values on survival after TAVI. Methods: 284 patients with severe AS underwent an RHC examination for hemodynamic assessment prior to TAVI and were categorized into subtypes of PH according to the 2015 European Society of Cardiology (ESC) guidelines. TAVI patients were followed-up with for one year with regard to 30-days and 1-year mortality as primary endpoints. Results: 74 of 284 participants showed a diastolic pressure gradient (DPG) < 7 mmHg and a pulmonary vascular resistance (PVR) > 3 Wood units (WU) and could not be formally allocated to either isolated post-capillary PH (ipc-PH) or combined pre- and post-capillary PH (cpc-PH). Therefore, a new subgroup called “borderline post-capillary PH” (borderlinepc-PH) was introduced. Compared with TAVI patients with pre-capillary PH (prec-PH), ipc-PH patients suffering from borderlinepc-PH (HR 7.114; 95% CI 2.015–25.119; p = 0.002) or cpc-PH (HR 56.459; 95% CI 7.738–411.924; p < 0.001) showed a significantly increased 1-year mortality. Conclusions: Postcapillary PH was expanded to include the so-called “borderlinepc-PH” variant in addition to the ipc-PH and cpc-PH subtypes. The one-year survival after TAVI was significantly different between the subgroups, with the worst prognosis for borderlinepc-PH and cpc-PH.

Details

Title
Conundrum of Classifying Subtypes of Pulmonary Hypertension—Introducing a Novel Approach to Classify “Borderline” Patients in a Population with Severe Aortic Stenosis Undergoing TAVI
Author
Boxhammer, Elke 1   VIAFID ORCID Logo  ; Gharibeh, Sarah X 1 ; Wernly, Bernhard 2   VIAFID ORCID Logo  ; Kelm, Malte 3 ; Marcus, Franz 4   VIAFID ORCID Logo  ; Kretzschmar, Daniel 4 ; Hoppe, Uta C 1 ; Lauten, Alexander 5 ; Lichtenauer, Michael 1 

 Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria 
 Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria 
 Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany 
 Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Departement of Cardiology, Friedrich Schiller University, 07737 Jena, Germany 
 Department of General and Interventional Cardiology and Rhythmology, Helios Clinic, 99084 Erfurt, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, 10115 Berlin, Germany 
First page
294
Publication year
2022
Publication date
2022
Publisher
MDPI AG
e-ISSN
23083425
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2716551995
Copyright
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.