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01.02.2012 | Original Paper

Prognostic value of mild-to-moderate pulmonary hypertension in patients with severe aortic valve stenosis undergoing aortic valve replacement

verfasst von: Christine S. Zuern, Christian Eick, Konstantinos Rizas, Cosmina Stoleriu, Barbara Woernle, Stephen Wildhirt, Christian Herdeg, Ulrich Stock, Meinrad Gawaz, Axel Bauer

Erschienen in: Clinical Research in Cardiology | Ausgabe 2/2012

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Abstract

Background

Optimal timing of elective aortic valve replacement (AVR) for severe aortic stenosis (AS) is challenging. Hence, a sensitive marker in AS patients indicating increasing risk after AVR would be of great clinical value. In the present study, we hypothesized that mild-to-moderate pulmonary hypertension (PH) assessed prior to AVR is a sensitive marker for adverse events in patients after successful AVR.

Methods

We enrolled 200 consecutive patients with severe AS undergoing AVR. Among them, 176 patients (88%) were symptomatic. Patients were divided according to systolic pulmonary artery pressure (PAP_sys) into three groups: no PH (PAP_sys <30 mmHg), mild-to-moderate PH (PAP_sys ≥30 and PAP_sys <60 mmHg) and severe PH (≥60 mmHg). Multivariable analyses were adjusted for age and gender and included PH, left ventricular ejection fraction ≤35%, renal insufficiency and logistic EuroSCORE ≥20%. Primary endpoint was death of any cause within 5 years after AVR.

Results

During follow-up, 23 patients died (cumulative 5-year mortality rate 14.6%). Patients without (n = 78), mild-to-moderate (n = 99) and severe PH (n = 23) had 5-year mortality rates of 2.6, 15.2 and 26.1% (p = 0.001). PAPsys ≥30 mmHg yielded an excellent level of sensitivity of 92.8%. On multivariable analysis, mild-to-moderate PH was the only independent risk factor (hazard ratio 4.9, 95% confidence interval 1.1–21.8).

Conclusions

In patients with severe AS undergoing AVR, mild-to-moderate PH is a strong and independent predictor of late mortality. Conversely, patients with normal PAP_sys have an extremely good prognosis.

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Titel: Prognostic value of mild-to-moderate pulmonary hypertension in patients with severe aortic valve stenosis undergoing aortic valve replacement
verfasst von: Christine S. Zuern
Christian Eick
Konstantinos Rizas
Cosmina Stoleriu
Barbara Woernle
Stephen Wildhirt
Christian Herdeg
Ulrich Stock
Meinrad Gawaz
Axel Bauer
Publikationsdatum: 01.02.2012
Verlag: Springer-Verlag
Erschienen in: Clinical Research in Cardiology / Ausgabe 2/2012
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-011-0367-3

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Prognostic value of mild-to-moderate pulmonary hypertension in patients with severe aortic valve stenosis undergoing aortic valve replacement