Changes in Pulmonary Hypertension Following Transcatheter Aortic Valve Implantation: Implications for Prognosis.

Pulmonary hypertension (PH) is a known prognostic factor in the setting of transcatheter aortic valve implantation (TAVI), but data on post-TAVI PH changes and their clinical relevance are limited. This retrospective cohort included 55 PH patients (52.7% male; mean age 81.5 ± 8.9 years) classified by pre-TAVI systolic pulmonary artery pressure into mild (36-50 mmHg), moderate (50-60 mmHg), and severe (≥60 mmHg) PH. PH was reassessed using the closest post-TAVI echocardiogram. The primary outcome was a 2-year composite of all-cause mortality or heart failure hospitalization. PH improved in 61.8% and worsened in 14.5% of patients after TAVI. Those with worsened PH had a significantly higher risk of adverse outcomes compared to those with no PH change (log-rank = 0.029), while event rates were similar between improved and unchanged PH groups (log-rank = 0.742). Cox regression analysis identified PH worsening as an independent predictor of adverse outcomes (HR: 8.775; 95% CI: 2.669-28.851; < 0.001). PH deterioration after TAVI appears to be associated with worse outcomes, possibly more indicative than PH improvement.