Echocardiographic pulmonary hypertension probability is associated with clinical outcomes after transcatheter aortic valve implantation

Nijenhuis, Vincent J.; Huitema, Marloes P.; Vorselaars, Veronique M.M.; Swaans, Martin J.; Kroon, Thomas de; Heyden, Jan A.S. Van der; Rensing, Benno J.; Heijmen, Robin H.; Berg, Jürrien M. ten; Post, Marco C.

doi:10.1016/j.ijcard.2016.10.010

Cited by 18 publications

(33 citation statements)

References 29 publications

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“…The majority of participants included in our meta‐analysis were derived from 2 large prospective registries, with the lack of information regarding delirium diagnostic criteria and timing of the delirium screening . Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR . Several participant‐ and procedural‐related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies.…”

Section: Discussionmentioning

confidence: 89%

“…When inclusion and exclusion criteria were applied, 31 publications remained for assessment. 6,8,9,11,17, Most included studies were observational (14 prospective, 6,17,23,[26][27][28][29][30]33,35,37,41,44,47 6 propensity matched, 22,24,25,36,40,42 10 retrospective 8,9,11,31,32,34,38,43,45,46 ), with only one randomized controlled trial. 39 Differences in the differential diagnosis between POD and other comparable cognitive disorders, including dementia, depression, and schizophrenia, are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…29,45 Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR. 6,8,9,11,17,[22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47 Several participant-and procedural-related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies. Larger studies are needed to identify clinical and procedural predictors of change in cognitive status early after TAVR, and to evaluate nonpharmacological strategies to reduce the incidence of IHPOD after TAVR.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Abawi

Pagnesi

Agostoni

et al. 2018

J American Geriatrics Society

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Objectives To evaluate the incidence of in‐hospital postoperative delirium (IHPOD) after transcatheter aortic valve replacement (TAVR). Design Systematic review and meta‐analysis. Setting Elective procedures Participants Individuals undergoing TAVR. Measurements A literature search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials (up to December 2017). All observational studies reporting the incidence of IHPOD after TAVR (sample size > 25) were included in our meta‐analysis. The reported incidence rates were weighted to obtain a pooled estimate rate with 95% confidence interval (CI). Results Of 96 potentially relevant articles, 31 with a total of 32,389 individuals who underwent TAVR were included in the meta‐analysis. The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in included studies, with a pooled estimate rate of 8.1% (95% CI=6.7–9.4%); heterogeneity was high (Q = 449; I = 93%; pheterogeneity < .001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4–9.1%) after transfemoral (TF) TAVR and 21.4% (95% CI=10.3–32.5%) after non‐TF TAVR. Conclusion Delirium occurs frequently after TAVR and is more common after non‐TF than TF procedures. Recommendations are made with the aim of standardizing future research to reduce heterogeneity between studies on this important healthcare problem. J Am Geriatr Soc 66:2417–2424, 2018.

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Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Abawi

Pagnesi

Agostoni

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

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“…However, some patients with severe pre-operative PH have a persistent severe postprocedural elevation in sPAP, which is associated with a higher mortality than in patients with the decrease in sPAP [ 13 ]. TAVI was found to be beneficial in decreasing sPAP [ 10 , 16 , 17 ]. Importantly, Sinning et al found that in 16 patients with remaining high sPAP (>60 mmHg) at 3 months after TAVI, 2-year mortality was higher as compared to 226 patients with sPAP reduced ≤60 mmHg [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the commonly used Society of Thoracic Surgeons score (STS) does not include PH as one of the risk factors during mortality assessment [ 8 ], whereas the EuroSCORE only considers the presence of severe PH with systolic pulmonary artery pressure (sPAP) >60 mm Hg. In addition, PH has been associated with short- and mid-term mortality after TAVI, but evidence is inconsistent [ 9 , 10 ]. TAVI has been shown to decrease sPAP significantly [ 11 , 12 ], a phenomenon associated with improved survival [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of tricuspid regurgitation velocity and probability of pulmonary hypertension in patients undergoing transcatheter aortic valve implantation

Kleczyński

Dziewierz

Wiktorowicz

et al. 2017

Int J Cardiovasc Imaging

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Pulmonary hypertension (PH) is associated with adverse clinical outcomes after transcatheter aortic valve implantation (TAVI). We sought to investigate the effects of tricuspid regurgitant velocity (TRV) and echocardiographic probability of PH on clinical outcomes of patients undergoing TAVI. A total of 148 consecutive patients undergoing TAVI were included and stratified as having “low” (TRV ≤2.8 m/s), “intermediate” (TRV 2.9–3.4 m/s), and “high” (TRV >3.4 m/s) probability of PH. Only the patients from the “high” probability group were considered as patients with PH. All-cause mortality, complications rate and quality of life (QoL) were assessed according to VARC-2 recommendations. Of 148 patients, 65 (43.9%) were considered as patients with PH. These presented with higher NYHA class at baseline (p = 0.027) and had more frequently a history of previous stroke/transient ischemic attack (p = 0.019). A difference in all-cause mortality was noted at 12 months [PH (−) vs. PH (+): 9.6 vs. 21.5%; p = 0.043]; however, it was no longer significant after adjustment for age and gender (OR 2.39, 95% CI 0.91–6.24; p = 0.08). Unadjusted and adjusted rates of all-cause death at maximal follow-up of 13.3 (6.0–31.1) months were higher in patients with PH. However, the presence of PH was not identified as an independent predictor of all-cause mortality at follow-up. No difference in other complications rates and QoL were noted. The presence of TRV >3.4 m/s indicating “high” probability of PH may predict impaired clinical outcomes after TAVI. No impact of PH on QoL outcomes was confirmed.

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CT measured pulmonary artery to ascending aorta ratio stratified by echocardiographically obtained systolic pulmonary artery pressure values for noninvasive detection of pulmonary hypertension in patients with severe aortic valve stenosis

et al. 2023

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Background Transthoracic echocardiography (TTE) offers a measurement method for the determination of pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) with determination of maximal tricuspid regurgitation velocity (TRVmax) and systolic pulmonary artery pressure (sPAP). Radiological parameters for noninvasive detection of PH, most importantly computed tomography (CT) based PA/AA-ratio = ratio of pulmonary artery diameter (PA) and ascending aorta diameter (AA), are also included in the latest ESC guidelines. The aim of the present study was to define cut-off values for PA/AA-ratio taking also into account cardiovascular biomarkers to determine criteria for noninvasive diagnosis of PH. Methods 194 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) underwent pre-procedural TTE and CT with measurement of PA/AA-ratio. Additionally, common cardiovascular biomarkers were determined. Results TAVR patients with an sPAP ≥ 40 mmHg or a TRVmax ≥ 2.9 m/s had a PA/AA-ratio ≥ 0.80 in an AUROC analysis. The cut-off value of ≥ 0.80 resulted in a significantly higher mortality rate (log-rank test: p = 0.034) in these patients in a Kaplan–Meier analysis regarding 1-year survival after TAVR. Significant differences in biomarker expression between patients with a PA/AA-ratio ≥ 0.80 or < 0.80 occurred for BNP (p = 0.001), cTnI (p = 0.032), GDF-15 (p = 0.002) and H-FABP (p = 0.015). Conclusion PA/AA-ratio ≥ 0.80 is a promising radiological parameter that can provide information about mortality in patients with severe AS undergoing TAVR; combined with biomarkers it may contribute to noninvasive detection of PH in patients with severe AS. Graphical abstract

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Echocardiographic pulmonary hypertension probability is associated with clinical outcomes after transcatheter aortic valve implantation

Cited by 18 publications

References 29 publications

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Prognostic value of tricuspid regurgitation velocity and probability of pulmonary hypertension in patients undergoing transcatheter aortic valve implantation

CT measured pulmonary artery to ascending aorta ratio stratified by echocardiographically obtained systolic pulmonary artery pressure values for noninvasive detection of pulmonary hypertension in patients with severe aortic valve stenosis

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