{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:07:08Z","timestamp":1783642028815,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Echocardiography has long been established as the primary noninvasive method for diagnosing pulmonary hypertension (PH) prior to transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis (AS). In recent years, radiological methods for diagnosing PH have been investigated. Measurements such as the computed tomography angiography (CTA)-derived pulmonary artery (PA) diameter and PA diameter\/body surface area (PA\/BSA) have shown promising results regarding their diagnostic strength. However, it has yet to be determined if a patient\u2019s sex has any impact on the effectiveness of these diagnostic measurements. Methods: In all, 271 patients (51.3% male, mean age 82.6 \u00b1 4.8 years) with severe AS undergoing TAVR were separated into male and female groups. The cut-off values for the diagnosis of PH were calculated for the CTA-derived PA diameter and PA\/BSA based on different systolic pulmonal artery pressure values (40\u201345\u201350 mmHg). Patients were then subclassified according to measurements above or below these PA diameters and PA\/BSA cut-off values. A PA diameter \u226529.5 mm and PA\/BSA \u2265 15.7 mm\/m2 qualified for PH. The 1\u20135 year survival rate in these cohorts was further analyzed. Results: Patients with a PA diameter \u226529.5 mm showed a significantly higher 1 year mortality rate (p = 0.014). This observation could only be confirmed for the male sex (p = 0.018) and not for the female sex (p = 0.492). As for the PA\/BSA, in patients over the cut-off value, no significant increase in mortality was noted in the overall cohort. However, the male patients showed increased 3 year (p = 0.048) and 5 year mortality rates (p = 0.033). Conclusions: The CTA-obtained PA diameter and PA\/BSA are both useful in the diagnosis of PH and mortality risk stratification in patients with severe AS undergoing TAVR, especially in males. Male patients with PA \u2265 29.5 mm or PA\/BSA \u2265 15.7 mm\/m2 seem to be at a higher risk of death during follow-up after undergoing TAVR. In females, no such correlation was observed.<\/jats:p>","DOI":"10.3390\/jcm13071999","type":"journal-article","created":{"date-parts":[[2024,3,31]],"date-time":"2024-03-31T13:32:56Z","timestamp":1711891976000},"page":"1999","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radiological Parameters for the Detection of Pulmonary Hypertension in Severe Aortic Valve Stenosis and Their Influence on Mortality: Does Sex Matter?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1644-1754","authenticated-orcid":false,"given":"Joseph","family":"Kletzer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Scharinger","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozan","family":"Demirel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhard","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Medved","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Reiter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Hammerer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Steinwender","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2405-2350","authenticated-orcid":false,"given":"Stefan","family":"Hecht","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7265-8560","authenticated-orcid":false,"given":"Kristen","family":"Kopp","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta C.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Hergan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6589-3853","authenticated-orcid":false,"given":"Elke","family":"Boxhammer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.tcm.2020.12.005","article-title":"Pulmonary hypertension in aortic valve stenosis","volume":"32","author":"Maeder","year":"2022","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/MAJ.0b013e3182309431","article-title":"Frequency, determinants and outcome of pulmonary hypertension in patients with aortic valve stenosis","volume":"343","author":"Mutlak","year":"2012","journal-title":"Am. J. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/echo.14611","article-title":"Correlation between Doppler echocardiography and right heart catheterization assessment of systolic pulmonary artery pressure in patients with severe aortic stenosis","volume":"37","author":"Schewel","year":"2020","journal-title":"Echocardiography"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.amjcard.2010.03.043","article-title":"Relation of left atrial dysfunction to pulmonary artery hypertension in patients with aortic stenosis and left ventricular systolic dysfunction","volume":"106","author":"Saraiva","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Boxhammer, E., Berezin, A.E., Paar, V., Bacher, N., Topf, A., Pavlov, S., Hoppe, U.C., and Lichtenauer, M. (2022). Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement. J. Pers. Med., 12.","DOI":"10.3390\/jpm12040603"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1016\/j.amjcard.2014.08.019","article-title":"Prognostic impact of pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve replacement for aortic stenosis","volume":"114","author":"Bishu","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1161\/CIRCINTERVENTIONS.113.000482","article-title":"Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: Study from the FRANCE 2 Registry","volume":"7","author":"Lucon","year":"2014","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kletzer, J., Hecht, S., Ramsauer, S., Scharinger, B., Kaufmann, R., Kammler, J., Kellermair, J., Akbari, K., Blessberger, H., and Steinwender, C. (2023). A Story of PA\/BSA and Biomarkers to Diagnose Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis-The Rise of IGF-BP2 and GDF-15. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10010022"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1161\/CIRCULATIONAHA.111.088427","article-title":"Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis","volume":"126","author":"Lancellotti","year":"2012","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Boxhammer, E., Scharinger, B., Kaufmann, R., Brandtner, H., Schmidbauer, L., Kammler, J., Kellermair, J., Reiter, C., Akbari, K., and Hammerer, M. (2022). Comparability between Computed Tomography Morphological Vascular Parameters and Echocardiography for the Assessment of Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis-Results of a Multi-Center Study. Diagnostics, 12.","DOI":"10.3390\/diagnostics12102363"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1007\/s00392-023-02182-8","article-title":"CT measured pulmonary artery to ascending aorta ratio stratified by echocardiographically obtained systolic pulmonary artery pressure values for noninvasive detection of pulmonary hypertension in patients with severe aortic valve stenosis","volume":"112","author":"Boxhammer","year":"2023","journal-title":"Clin. Res. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1055\/a-1966-0039","article-title":"Cardiovascular Disease in Women: What the Radiologist Needs to Know","volume":"195","author":"Sommer","year":"2023","journal-title":"Rofo"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.33963\/KP.a2022.0173","article-title":"Prognostic value of computed tomography derived measurements of pulmonary artery diameter for long-term outcomes after transcatheter aortic valve replacement","volume":"80","author":"Kalinczuk","year":"2022","journal-title":"Pol. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1016\/j.jcin.2021.08.023","article-title":"Impact of Pulmonary Artery Dilatation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement","volume":"14","author":"Koseki","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e256","DOI":"10.1097\/MD.0000000000000256","article-title":"CT-based pulmonary artery measurement in the detection of pulmonary hypertension: A meta-analysis and systematic review","volume":"93","author":"Shen","year":"2014","journal-title":"Medicine"},{"key":"ref_17","first-page":"e25319","article-title":"Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating with Echocardiography: A Study at a Tertiary Care Hospital","volume":"14","author":"Rehman","year":"2022","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijcard.2021.12.019","article-title":"Baseline PA\/BSA ratio in patients undergoing transcatheter aortic valve replacement\u2014A novel CT-based marker for the prediction of pulmonary hypertension and outcome","volume":"348","author":"Sudo","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e006539","DOI":"10.1161\/CIRCHEARTFAILURE.119.006539","article-title":"Sex-Related Differences in Heart Failure with Preserved Ejection Fraction","volume":"12","author":"Dewan","year":"2019","journal-title":"Circ. Heart Fail"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1038\/s41598-018-19507-7","article-title":"Gender-related differences in heart failure with preserved ejection fraction","volume":"8","author":"Duca","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3452","DOI":"10.1093\/eurheartj\/ehu193","article-title":"Right heart dysfunction in heart failure with preserved ejection fraction","volume":"35","author":"Melenovsky","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"727558","DOI":"10.3389\/fragi.2021.727558","article-title":"Sex Differences in Pulmonary Hypertension","volume":"2","year":"2021","journal-title":"Front. Aging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jcmg.2017.12.015","article-title":"Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement","volume":"12","author":"Asami","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"677","DOI":"10.2459\/JCM.0000000000000714","article-title":"Physical activity in premenopausal women with asymptomatic peripheral arterial disease","volume":"19","author":"Mattioli","year":"2018","journal-title":"J. Cardiovasc. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/1999\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:20:55Z","timestamp":1760106055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/1999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,29]]},"references-count":24,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13071999"],"URL":"https:\/\/doi.org\/10.3390\/jcm13071999","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,29]]}}}