Pulmonary Hypertension Risk Estimation Changes May Predict Mortality After Valve Replacement

Incorporating preoperative right heart measurements into the standard pulmonary hypertension (PH) risk estimation model may allow for better risk stratification following aortic valve replacement, according to study results published in CHEST.

Echocardiographic parameters were measured from patients with severe aortic stenosis undergoing aortic valve replacement who were divided into “low,” “medium,” or “high” groups based on risk of PH. The associations of 2 echocardiographic signs (in addition to tricuspid regurgitation velocity), right atrial area >18 cm² and the ratio of right ventricle/left ventricle basal diameter >1, were then evaluated based on PH risk and compared between groups.

Of the 429 consecutive patients enrolled in the study, 247 were considered low risk, 117 intermediate risk, and 65 high risk of developing PH according to standard risk estimation models. High risk for PH was an independent predictor of mortality, but intermediate or low risk was not. Furthermore, when the intermediate group was subdivided based on the 2 additional echocardiographic signs, patients with right atrial area >18 cm² and the ratio of right ventricle/left ventricle basal diameter >1 had higher mortality rates than patients without those findings (hazard ratio, 2.13; 95% CI, 1.11-4.10; P =.02).

“The echocardiographic estimation of the ‘intermediate’ PH probability group with additional measures of the right heart together with peak [tricuspid regurgitation velocity], allows a better stratification of preoperative severity of PH in patients with aortic stenosis, since the enlargement of the right cavities implies a greater degree of pressure overload,” the researchers wrote. They suggested that further studies are needed to confirm and validate these findings.

Reference

Cladellas M, Garcia-Ribas C, Ble M, et al. Impact of preoperative right heart chambers measurement in the evaluation of pulmonary hypertension after aortic valve replacement [published online January 17, 2020]. CHEST. doi:10.1016/j.chest.2019.12.017