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Circ Cardiovasc Interv. 2014 Apr;7(2):240-7. doi: 10.1161/CIRCINTERVENTIONS.113.000482. Epub 2014 Feb 25.

Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: study from the FRANCE 2 Registry.

Author information

1
From the Service de Cardiologie (A.L., M.B., D.B., H.L.B.), Service de Pharmacologie Clinique (E.O.), and Service de Chirurgie Thoracique et Cardiovasculaire (J.P.V., A.L.), CHU Rennes, Rennes, France; Département de Pharmacologie, Clinique et Expérimentale, Faculté de Médecine (E.O.) and LTSI (J.P.V., H.L.B.), Université de Rennes 1, Rennes, France; INSERM 0203, Centres d'Investigation Clinique, Rennes, France (E.O.); INSERM, U642, Rennes, France (J.P.V., H.L.B.); CHU Rouen, Hôpital Charles Nicolle, INSERM Unité 1096, Rouen, France (H.E.); CHU Bichat, Paris, France (B.I.); CHU Dupuytren, Limoges, France (M.L.); CHU Pitié-Salpêtrière, Paris, France (P.L.); and CHU Brest, Brest, France (M.G.).

Abstract

BACKGROUND:

Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis. The aim of this multicenter study was to describe clinical outcome after transcatheter aortic valve implantation.

METHODS AND RESULTS:

The FRANCE 2 Registry included all patients undergoing transcatheter aortic valve implantation in France in 2010 and 2011. Patients were divided into 3 groups depending on systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP <40 mm Hg (no PH); group II, sPAP 40 to 59 mm Hg (mild-to-moderate PH); and group III, sPAP ≥60 mm Hg (severe PH). Patients were followed up for 1 year. A total of 2435 patients whose pre-transcatheter aortic valve implantation sPAP was reported were included. A total of 845 were in group I (34.7%), 1112 in group II (45.7%), and 478 in group III (19.6%). Procedural success, early complications, and 30-day mortality were statistically similar across sPAP groups. One-year mortality was higher in groups II and III (group I, 22%; group II, 28%; and group III, 28%; P=0.032). Mild-to-moderate and severe PH were identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. New York Health Association functional class improved significantly in all groups.

CONCLUSIONS:

PH (sPAP ≥40 mm Hg) in patients with aortic stenosis undergoing transcatheter aortic valve implantation was associated with increased 1-year mortality especially when severe (sPAP ≥60 mm Hg) but not with increased 30-day mortality, and functional status was significantly improved regardless of PAP level.

KEYWORDS:

aortic valve stenosis; hypertension, pulmonary

[Indexed for MEDLINE]

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