Impact of preoperative right heart chambers measurement in the evaluation of pulmonary hypertension after aortic valve replacement.

Abstract Background Severe pulmonary hypertension (PH) in patients with aortic stenosis is related to poor prognosis after aortic valve replacement (AVR). Current European PH guidelines recommend adding two different echocardiographic signs to tricuspid regurgitation velocity (TRV) in PH estimation, classifying its probability as “low” (TRV≤2.8m/s), “intermediate” (TRV 2.9-3.4m/s) and “high” (TRV>3.4m/s). Right ventricle (RV) is an important determinant of prognosis in PH. Our aim was to analyze the value of right atrial area>18cm2 and RV/left ventricle ratio>1 in the long-term prognosis after AVR, mainly in the “intermediate” group. Methods We included 429 consecutive patients (mean age 73±8 years, 55% males) with median follow-up of 4.25 years (completed in 98%). Patients were divided into “low” (n=247), “intermediate” (n=117) and “high” groups (n=65). The “intermediate” group was divided into 2 subgroups: “subgroup 2a” (n=27, TRV non-measurable or ≤2.8m/s and two signs present) and “subgroup 2b” (n=90, TRV 2.9-3.4m/s and none or only one sign present). Results Overall mortality rates during follow-up of the “low”, “intermediate” and “high” were 24%, 32% and 42%, respectively. “High” PH probability was an independent predictor of all-cause mortality (HR 1.82; 95% CI:1.11-3.00), but the "intermediate" group did not reach significance after multivariate analysis (HR 1.40; 95% CI: 0.91-2.16). When the "intermediate" group was divided into subgroups, “subgroup 2a” mortality rate (56%) was higher than that of both “subgroup 2b” (24%, p=0.002) and the "low" group (24%, p Conclusions Incorporating right cavities measures to the PH probability model in the assessment of long-term prognosis after AVR, allows better risk discrimination, especially in the “intermediate” group.