Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR.

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 (D PA) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR. 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. D PA was calculated as: [(area-MPA max –area-MPA min)/area-MPA max ]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of D PA for persistent-PH. Two groups were compared based on a D PA 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 D PA <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 D PA >8%. Adjusted multivariable regression analyses showed that D PA <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 D PA <8% was significantly higher compared to patients with D PA ≥8% (mortality 28% vs 15%; log-rank p =0.003). D PA on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR. [ABSTRACT FROM AUTHOR]