Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR.

Rationale and Objectives: Post-TAVR persistent pulmonary hypertension (PH) is a better predictor of poor outcome than pre-TAVR PH. In this longitudinal study we sought to evaluate whether pulmonary artery (distensibility (D _PA ) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR.
Materials and Methods: Three hundred and thirty-six patients undergoing TAVR between July 2012 and March 2016 were retrospectively included and followed for all-cause mortality until November 2017. All patients underwent retrospectively ECG-gated CTA prior to TAVR. Main pulmonary artery (MPA) area was measured in systole and in diastole. D _PA was calculated as: [(area-MPA _max -area-MPA _min )/area-MPA _max ]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of D _PA for persistent-PH. Two groups were compared based on a D _PA threshold of 8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard, and logistic regression analyses were performed. The primary clinical endpoint was defined as persistent-PH post-TAVR. The secondary endpoint was defined as all-cause mortality 2 years after TAVR.
Results: Median follow-up time was 413 (interquartiles 339-757) days. A total of 183 (54%) had persistent-PH and 68 (20%) patients died within 2-years after TAVR. Patients with D _PA <8% had significantly more persistent-PH (67% vs 47%, p<0.001) and 2-year deaths (28% vs 15%, p=0.006), compared to patients with D _PA >8%. Adjusted multivariable regression analyses showed that D _PA <8% was independently associated with persistent-PH (OR 2.10 [95%-CI 1.3-4.5], p=0.007) and 2-year mortality (HR 2.91 [95%-CI 1.5-5.8], p=0.002). Kaplan-Meier analysis showed that 2-year mortality of patients with D _PA <8% was significantly higher compared to patients with D _PA ≥8% (mortality 28% vs 15%; log-rank p=0.003).
Conclusion: D _PA on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)