Pulmonary hypertension (PH) is a frequent complication in patients with aortic stenosis (AS) and is generally associated with adverse outcomes. However, the clinical significance of changes in PH following transcatheter aortic valve implantation (TAVI) has not been fully elucidated. We examined data from a prospective, multicenter TAVI registry across six Japanese institutions, estimating pulmonary artery systolic pressure through echocardiographic transtricuspid pressure gradient (TRPG). A total of 2,056 patients were categorized based on pre-TAVI TRPG into a PH-negative group (TRPG < 30 mmHg, n = 1,407, 61.9 percent) and a PH-positive group (TRPG ≥ 30 mmHg, n = 649, 28.6 percent). The PH-positive cohort was further divided after TAVI (4.1 ± 5.3 days) into Recovered PH (TRPG < 30 mmHg, n = 253) and Persistent PH (TRPG ≥ 30 mmHg, n = 396). Over a median follow-up of 1.8 years, the primary endpoint was a composite of cardiovascular death and heart failure hospitalization, with secondary endpoints including each component individually. Kaplan-Meier analysis demonstrated higher event rates in the Persistent PH group, and multivariate Cox regression revealed that each 10 mmHg decrease in TRPG post-TAVI was associated with a 24% reduction in risk of the primary endpoint (HR: 0.76, 95% CI: 0.64–0.90, p = 0.002). These findings indicate that resolution of PH may partially underlie the improved prognosis observed after TAVI in AS patients with elevated pulmonary pressures.
