Hemodynamic Assessment to Evaluate Pulmonary Hypertension in Patients with Aortic Stenosis

Abstract

Pulmonary hypertension (PHT) is highly prevalent
in patients with Aortic Stenosis (AS) and significantly increases
mortality. Correlation between echocardiogram derived right
ventricular pressure and measured pulmonary artery systolic
pressure (PASP) by right heart catheterization (RHC) have been
reported to be poor. Retrospective data of 56 patients with AS
who underwent coronary angiography and RHC from June 1999
to 2008 were reviewed. 20 patients (35.1%) had severe PHT with
PASP > 55 mmHg on RHC. PASP did correlate with the body
weight (r = 0.473, p<0.01). There was a significant correlation
between PASP on RHC and RVSP on echo (r = 0.344 p<0.01) but
a Bland-Altman plot showed poor association. In patients with
PVR < 3, there was correlation between the PASP and LVEDP
on RHC (r = 0.655, p<0.001). 34 patients had an estimated RVSP
<40 mm Hg on echo and 9 (25.7%) of these patients had severe
PHT on RHC. Using a RVSP cutoff of 40 mmHg, echo had 46.8%
sensitivity. There was higher mortality at 3 years in patients with
severe PHT (44% vs. 10.7%, p <0.01) Conclusions: Severe PHT
was found in up to 35% of patients with AS and had higher
mortality. Obese patients with AS had a higher likelihood of
severe PHT. Echocardiography underestimates PHT in patients
with AS. PHT is related to diastolic dysfunction in these patients.
RHC should be considered in select patients with aortic stenosis
in order to risk stratify and assess for early aortic valve
replacement, in patients in whom a reliable TR jet velocity is
unobtainable by echo Doppler.