Rationale and Objectives
Post-TAVR persistent pulmonary hypertension (PH) is a better predictor of poor outcome than pre-TAVR PH. In this longitudinal study we sought to evaluate whether pulmonary artery (distensibility (DPA) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR.
Materials and Methods
Three hundred and thirty-six patients undergoing TAVR between July 2012 and March 2016 were retrospectively included and followed for all-cause mortality until November 2017. All patients underwent retrospectively ECG-gated CTA prior to TAVR. Main pulmonary artery (MPA) area was measured in systole and in diastole. DPA was calculated as: [(area-MPAmax–area-MPAmin)/area-MPAmax]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of DPA for persistent-PH. Two groups were compared based on a DPA threshold of 8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard, and logistic regression analyses were performed. The primary clinical endpoint was defined as persistent-PH post-TAVR. The secondary endpoint was defined as all-cause mortality 2 years after TAVR.
Median follow-up time was 413 (interquartiles 339–757) days. A total of 183 (54%) had persistent-PH and 68 (20%) patients died within 2-years after TAVR. Patients with DPA<8% had significantly more persistent-PH (67% vs 47%, p<0.001) and 2-year deaths (28% vs 15%, p=0.006), compared to patients with DPA>8%. Adjusted multivariable regression analyses showed that DPA<8% was independently associated with persistent-PH (OR 2.10 [95%-CI 1.3–4.5], p=0.007) and 2-year mortality (HR 2.91 [95%-CI 1.5–5.8], p=0.002). Kaplan-Meier analysis showed that 2-year mortality of patients with DPA<8% was significantly higher compared to patients with DPA≥8% (mortality 28% vs 15%; log-rank p=0.003).
DPA on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR.
Abbreviations:DPA (Pulmonary artery distensibility), MPA (Main pulmonary artery), PH (Pulmonary hypertension), RVSP (Right ventricular systolic pressure), STS (Society of Thoracic Surgeons)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Academic Radiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement.EuroIntervention. 2014; 9: 1042-1049
- Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis.Int J Cardiovasc Imaging. 2017; 33: 1637-1651
- Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: study from the FRANCE 2 registry.Circ Cardiovasc Interv. 2014; 7: 240-247
- Impact of pulmonary hypertension hemodynamic status on long-term outcome after transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2019; 12: 2155-2168
- Impact of right ventricular dysfunction and tricuspid regurgitation on outcomes in patients undergoing transcatheter aortic valve replacement.J Am Soc Echocardiogr. 2017; 30: 36-46
- Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis.J Thorac Cardiovasc Surg. 2011; 141: 1424-1430
- Persistence of severe pulmonary hypertension after transcatheter aortic valve replacement: incidence and prognostic impact.Circ Cardiovasc Interv [Internet]. 2016; 9 ([cited 2020 Jan 27])
- Pulmonary hypertension in patients with severe aortic stenosis: prognostic impact after transcatheter aortic valve replacement.JACC Cardiovasc Imaging. 2019; 12: 591-601
- Relation between pressure and diameter in main pulmonary artery of man.J Appl Physiol. 1963; 18: 557-559
- Compliance of the human pulmonary arterial system in disease.Circ Res. 1971; 29: 40-50
- Alteration of the pulsatile load in the high-altitude calf model of pulmonary hypertension.J Appl Physiol. 1991; 70: 859-868
- Pulmonary hypertension: ECG-gated 64-section CT angiographic evaluation of new functional parameters as diagnostic criteria.Radiology. 2009; 250: 558-566
- Pulmonary hypertension due to left heart disease: diagnostic value of pulmonary artery distensibility.Eur Radiol [Internet]. 2020; 30: 6204-6212
- Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance.JACC Cardiovasc Imaging. 2009; 2: 286-295
- Excess collagen in hypertensive pulmonary arteries decreases vascular distensibility.Am J Respir Crit Care Med. 1994; 149: 1317-1326
- Pulmonary vascular mechanics: important contributors to the increased right ventricular afterload of pulmonary hypertension: pulmonary vascular mechanics in hypoxic pulmonary hypertension.Exp Physiol. 2013; 98: 1267-1273
- Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension.J Am Coll Cardiol. 2006; 47: 799-803
- Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension.Chest. 2007; 132: 1906-1912
- Pulmonary hypertension due to left heart disease.Eur Respir J. 2019; 531801897
- Pulmonary artery compliance: its role in right ventricular-arterial coupling.Cardiovasc Res. 1992; 26: 839-844
- CTA pulmonary artery enlargement in patients with severe aortic stenosis: prognostic impact after TAVR.J Cardiovasc Comput Tomogr. 2021; 15: 431-440
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22: 1-23
- Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography.Echo Res Pract. 2021; 8: G19-G59
- Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography.J Am Soc Echocardiogr. 2019; 32: 1-64
- Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713
- Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects.Circulation. 2001; 104: 2797-2802
- Impact of periprocedural pulmonary hypertension on outcomes after transcatheter aortic valve replacement.J Am Coll Cardiol. 2022; 80: 1601-1613
- Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis.Heart. 2011; 97: 612-622
- Clinical profile, prognostic implication, and response to treatment of pulmonary hypertension in patients with severe aortic stenosis.Am J Cardiol. 2011; 107: 1046-1051
- Reversibility of pulmonary artery hypertension in aortic stenosis after aortic valve replacement.Ann Thorac Surg. 1990; 50: 89-93
Published online: May 04, 2023
Accepted: March 13, 2023
Received in revised form: March 10, 2023
Received: January 4, 2023
Publication stageIn Press Corrected Proof
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.