Left ventricular end diastolic pressures are associated with short and long term mortality rates following trans-catheter aortic valve replacement

Background: Left ventricle end diastolic pressure (LVEDP) measured during cardiac catheterization is an independent predictor of prognosis in acute myocardial infarction. We evaluated the prognostic value of postprocedural LVEDP in a large cohort of severe aortic stenosis patients treated with transcatheter aortic valve Replacement (TAVR).

Methods: Consecutive patients (n=845) with severe symptomatic aortic stenosis undergoing TAVR were divided into 2 groups according to post-procedural LVEDP above and below 10 mmHg. Collected data included patient characteristics, medical background, left ventricle ejection fraction (LVEF), frailty score, Society of Thoracic Surgeons (STS) score, periprocedural laboratory results and clinical outcomes.

Results: Median follow-up was 29.5 months (IQR 16.5-48.0). The mean age (±SD) was 82.3±6.2 years, mean STS score was 4.0%±3.0% and mean estimated LVEF was 56.9±6.6%. Patients with LVEDP>10 mmHg (75%) and LVEDP4%, respectively (P>0.01). Post procedural LVEDP>10 mmHg was independently associated with all-cause mortality (HR 1.83, 95% CI 1.13 to 2.97, p=0.01) during long-term follow-up.

Conclusions: Elevated post-procedural LVEDP is an independent predictor of short- and long-term mortality following TAVR, and might present a potential guidance for postprocedural management.