Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Patients with severe aortic valve stenosis and concomitant pulmonary hypertension show a significantly reduced survival prognosis. Right heart catheterization as a preoperative diagnostic tool to determine pulmonary hypertension has been largely abandoned in recent years in favor of echocardiographic criteria. Clinically, determination of echocardiographically estimated systolic pulmonary artery pressure falls far short of invasive right heart catheterization data in terms of accuracy. The aim of the present systematic review was to highlight noninvasive possibilities for the detection of pulmonary hypertension in patients with severe aortic valve stenosis, with a special focus on cardiovascular biomarkers. A total of 525 publications regarding echocardiography, cardiovascular imaging and biomarkers related to severe aortic valve stenosis and pulmonary hypertension were analyzed in a systematic database analysis using PubMed Central®. Finally, 39 publications were included in the following review. It was shown that the current scientific data situation, especially regarding cardiovascular biomarkers as non-invasive diagnostic tools for the determination of pulmonary hypertension in severe aortic valve stenosis patients, is poor. Thus, there is a great scientific potential to combine different biomarkers (biomarker scores) in a non-invasive way to determine the presence or absence of PH.

Elevated systolic pulmonary artery pressure is a substantial predictor of increased mortality after transcatheter aortic valve replacement in males, not in females

“…Pulmonary artery pressure (PAP), right atrial pressure (RAP) and at least sPAP was calculated as described previously [ 6 ]. As part of an extensive literature search and a self-authored review on the topic of non-invasive ways of determining PH in severe AS, the most commonly used sPAP cut-off values of 40 and 50 mmHg were used [ 1 , 7 , 8 ]. To also assess the severity of echocardiographically determined PH, patients were further subdivided into no PH by sPAP < 35 mmHg, mild PH by sPAP 35–50 mmHg, moderate PH by sPAP 51–70 mmHg and severe PH by sPAP > 70 mmHg [ 9 ].…”

“…Pulmonary hypertension (PH) holds significant importance as a risk determinant in cases of severe aortic valve stenosis (AS) preceding transcatheter aortic valve replacement (TAVR). Its presence adversely influences patient outcomes, linked to elevated risks of fatality and heart failure [ 1 , 2 ]. Echocardiography stands as the predominant non-invasive technique for detecting PH in severe AS cases.…”

The Clinical Noteworthiness of Plasma NT‐ProBNP Standard in Sufferers with Cardiogenic Cerebral Embolism and Its Diagnostic Value for Such Sufferers

“…Contrast Media & Molecular Imaging biologically inactive NT-proBNP and biologically active BNP. Bioactive BNP and NT-proBNP, both of which have the same clinical noteworthiness, but NT-proBNP has a longer half-life than BNP, so it has more tabulations in the plasma [18]. When brain cells are insufficient, cerebral vasodilation can lead to the rapid release of NT-proBNP in brain cells into the blood, thereby regulating cerebrovascular function.…”

“…The relationship between serum NT-proBNP standards and neurological impairment scores shows that there was an extensive positive correlation ( r = 0.845, P < 0.001) because BNP is a neurohormone secreted by ventricular myocytes, initially synthesized as a precursor of the brain natriuretic peptide and then cracked into biologically inactive NT-proBNP and biologically active BNP. Bioactive BNP and NT-proBNP, both of which have the same clinical noteworthiness, but NT-proBNP has a longer half-life than BNP, so it has more tabulations in the plasma [ 18 ]. When brain cells are insufficient, cerebral vasodilation can lead to the rapid release of NT-proBNP in brain cells into the blood, thereby regulating cerebrovascular function.…”

Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis—Results of a Multi-Center Study

“…Since right heart catheterization is no longer routinely performed prior to TAVR, transthoracic echocardiography is currently used in clinical practice as the gold standard to assess the presence of PH [ 8 , 9 ]. In most cases, the systolic pulmonary artery pressure (sPAP) is determined, which consists of the determination of the maximal continuous wave Doppler regurgitation velocity across the tricuspid valve and the estimation of the central venous pressure via the diameter and respiratory variability of the inferior vena cava.…”