TY - JOUR
T1 - Elevated systolic pulmonary artery pressure is a substantial predictor of increased mortality after transcatheter aortic valve replacement in males, not in females.
AU - Boxhammer, Elke
AU - Dienhart, Christiane
AU - Kletzer, Joseph
AU - Ramsauer, Susanne
AU - Kopp, Kristen
AU - Prinz, Erika
AU - Wintersteller, Wilfried
AU - Blessberger, Hermann
AU - Hammerer, Matthias
AU - Steinwender, Clemens
AU - Lichtenauer, Michael
AU - Hoppe, Uta
N1 - Boxhammer, Kletzer, Ramsauer, Kopp, Prinz, Wintersteller, Hammerer, Lichtenauer, Hoppe: Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria; Dienhart: Department of Internal Medicine I, Division of Gastroenterology, Hepathology, Nephrology, Metabolism and Diabetology, Paracelsus Medical University of Salzburg, Salzburg, Austria
PY - 2023
Y1 - 2023
N2 - BackgroundWhile pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) is associated with increased mortality after transcatheter aortic valve replacement (TAVR), there is limited data on gender differences in the effects on long-term survival.ObjectiveThe aim of this retrospective, multicenter study was to investigate the prognostic impact of pre-interventional PH on survival of TAVR patients with respect to gender.Methods303 patients undergoing TAVR underwent echocardiography to detect PH prior to TAVR via measurement of systolic pulmonary artery pressure (sPAP). Different cut-off values were set for the presence of PH. The primary endpoint was all-cause mortality at 1, 3 and 5 years.ResultsKaplan-Meier analysis by gender showed that only males exhibited significant increased mortality at elevated sPAP values during the entire follow-up period of 5 years (sPAP & GE; 40 mmHg: p & LE; 0.001 and sPAP & GE; 50 mmHg: p & LE; 0.001 in 1- to 5-year survival), whereas high sPAP values had no effect on survival in females. In Cox regression analysis based on the selected sPAP thresholds, male gender was an independent risk factor for long-term mortality after TAVR in all time courses.ConclusionMale gender was an isolated risk factor for premature death after TAVR in patients with echocardiographic evidence of PH and severe AS. This could mean that, the indication for TAVR should be discussed more critically in men with severe AS and an elevated sPAP, while in females, PH should not be an exclusion criterion for TAVR.Graphical abstractGraphical abstract of the study (Created with BioRender.com)Image material of CoreValve & TRADE; Evolut & TRADE; was kindly provided by & COPY; Medtronic Inc.Graphical abstractGraphical abstract of the study (Created with BioRender.com)Image material of CoreValve & TRADE; Evolut & TRADE; was kindly provided by & COPY; Medtronic Inc.
AB - BackgroundWhile pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) is associated with increased mortality after transcatheter aortic valve replacement (TAVR), there is limited data on gender differences in the effects on long-term survival.ObjectiveThe aim of this retrospective, multicenter study was to investigate the prognostic impact of pre-interventional PH on survival of TAVR patients with respect to gender.Methods303 patients undergoing TAVR underwent echocardiography to detect PH prior to TAVR via measurement of systolic pulmonary artery pressure (sPAP). Different cut-off values were set for the presence of PH. The primary endpoint was all-cause mortality at 1, 3 and 5 years.ResultsKaplan-Meier analysis by gender showed that only males exhibited significant increased mortality at elevated sPAP values during the entire follow-up period of 5 years (sPAP & GE; 40 mmHg: p & LE; 0.001 and sPAP & GE; 50 mmHg: p & LE; 0.001 in 1- to 5-year survival), whereas high sPAP values had no effect on survival in females. In Cox regression analysis based on the selected sPAP thresholds, male gender was an independent risk factor for long-term mortality after TAVR in all time courses.ConclusionMale gender was an isolated risk factor for premature death after TAVR in patients with echocardiographic evidence of PH and severe AS. This could mean that, the indication for TAVR should be discussed more critically in men with severe AS and an elevated sPAP, while in females, PH should not be an exclusion criterion for TAVR.Graphical abstractGraphical abstract of the study (Created with BioRender.com)Image material of CoreValve & TRADE; Evolut & TRADE; was kindly provided by & COPY; Medtronic Inc.Graphical abstractGraphical abstract of the study (Created with BioRender.com)Image material of CoreValve & TRADE; Evolut & TRADE; was kindly provided by & COPY; Medtronic Inc.
U2 - 10.1007/s00392-023-02307-z
DO - 10.1007/s00392-023-02307-z
M3 - Original Article
C2 - 37750991
SN - 1861-0684
JO - CLINICAL RESEARCH IN CARDIOLOGY : OFFICIAL JOURNAL OF THE GERMAN CARDIAC SOCIETY
JF - CLINICAL RESEARCH IN CARDIOLOGY : OFFICIAL JOURNAL OF THE GERMAN CARDIAC SOCIETY
ER -