부산대학교 도서관

Background: Pulmonary hypertension (PHT) is common in patients with severe aortic valve stenosis (AS) and associated with a poor prognosis when not treated with aortic valve replacement. In patients undergoing transcatheter aortic valve implantation (TAVI), the clinical relevance of PHT has not been reported before. Therefore our aim was to study the factors associated with PHT, the change in pulmonary artery pressure (PAP) after TAVI and the possible prognostic value of PHT in these patients.Methods: We included 96 patients (age 82±7 years, 38 male) with severe AS, who underwent TAVI with the Medtronic-CoreValve device. Transthoracic echocardiography was performed before the procedure and 3 months after the procedure. PAP was calculated with the following formula: 4*(tricuspid regurgitation peak velocity)2 + right atrial pressure.Results: Before TAVI, 41 patients had a PAP<40 mmHg and 55 patients a PAP≥40 mmHg. A higher PAP was associated with a higher serum creatinine level (111±61 vs. 83±28 μmol/l, p=0.006) and a lower indexed effective orifice area (0.38±0.10 vs. 0.42±0.10 cm2/m2, p=0.04) at baseline. Mortality at 3 months was not significantly different between both groups (20% vs. 20%, p=1.0). After three months the PAP did not change significantly compared with baseline: 40±11 vs. 42±11 mmHg, p=0.12. Patients with a decrease in PAP had a higher baseline PAP compared with patients without a decrease in PAP (49±11 vs. 36±10 mmHg, p<0.0001).Conclusion: In patients undergoing transcatheter aortic valve implantation, pulmonary hypertension is associated with preprocedural renal failure and more severe aortic valve stenosis, but not associated with post-procedural early mortality. A decrease in PHT after TAVI is observed in patients with higher baseline pulmonary artery pressures.