Pulmonary hypertension as a prognostic marker in low-flow low-gradient aortic stenosis: Insights from invasive hemodynamics and post-TAVR outcomes.

INTRODUCTION

Pulmonary hypertension (PH) is a common and significant comorbidity in patients with low-flow low-gradient (LF-LG) aortic stenosis, impacting prognosis after transcatheter aortic valve replacement (TAVR). Non-invasive tools often fail to capture PH's full clinical impact due to inherent limitations. This study evaluates the prognostic significance of PH measured invasively and explores its implications on post-TAVR outcomes.

METHODS

This retrospective study analyzed 90 patients with symptomatic LF-LG aortic stenosis who underwent TAVR. Pulmonary artery systolic pressure (PASP) was categorized as mild (<35 mmHg), moderate (35-50 mmHg), or severe (>50 mmHg) using invasive right heart catheterization. Key endpoints included 12-month all-cause mortality and heart failure rehospitalization, assessed via Kaplan-Meier survival analysis and Cox proportional hazards modeling.

RESULTS

PH was present in 50% of patients, with moderate-to-severe cases showing higher mortality (25% vs. 8%, p < 0.001) and rehospitalization rates (20% vs. 6%, p = 0.02). Baseline PASP emerged as an independent predictor of mortality (HR 1.07 per mmHg, p < 0.001) and rehospitalization (HR 1.04 per mmHg, p = 0.01). Subgroup analyses revealed that patients with concomitant COPD or advanced diastolic dysfunction exhibited worse outcomes, underscoring the role of systemic disease burden.

CONCLUSION

Invasive hemodynamic assessment provides superior prognostic insight for PH in LF-LG aortic stenosis patients. The findings advocate for targeted PH management strategies to improve post-TAVR outcomes and challenge the sole reliance on non-invasive methods in high-risk cohorts.