Comparison of Transvalvular Aortic Mean Gradients Obtained by Intraprocedural Echocardiography and Invasive Measurement in Balloon and Self-Expanding Transcatheter Valves

被引:51
作者
Abbas, Amr E. [1 ,2 ]
Mando, Ramy [1 ]
Kadri, Amer [1 ]
Khalili, Houman [3 ]
Hanzel, George [1 ,2 ]
Shannon, Francis [1 ,2 ]
Al-Azizi, Karim [4 ]
Waggoner, Thomas [5 ]
Kassas, Safwan [6 ]
Pilgrim, Thomas [7 ]
Okuno, Taishi [7 ]
Camacho, Alexander [8 ]
Selberg, Alexandra [8 ]
Elmariah, Sammy [8 ]
Bavry, Anthony [9 ]
Ternacle, Julien [10 ]
Christensen, Jared [4 ]
Gheewala, Neil [5 ]
Pibarot, Philippe [10 ]
Mack, Michael [4 ]
机构
[1] Beaumont Hosp Royal Oak, Royal Oak, MI 48073 USA
[2] Oakland Univ, William Beaumont Sch Med, Auburn Hills, MI USA
[3] Delray Med Ctr, Delray Beach, FL USA
[4] Heart Hosp Baylor Plano, Plano, TX USA
[5] Tucson Med Ctr, Pima Heart & Vasc, Tucson, AZ USA
[6] Ascens St Marys Hosp, Saginaw, MI USA
[7] Bern Univ Hosp, Bern, Switzerland
[8] Massachusetts Gen Hosp, Boston, MA 02114 USA
[9] Univ Florida, Gainesville, FL USA
[10] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ, Canada
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2021年 / 10卷 / 19期
关键词
Bernoulli equation; echocardiographic and invasive discordance; pressure recovery; transcatheter aortic valve replacement; EUROPEAN ASSOCIATION; CATHETER GRADIENTS; IN-VITRO; DOPPLER ASSESSMENT; AMERICAN SOCIETY; POST-TAVR; REPLACEMENT; RECOMMENDATIONS; IMPLANTATION; STENOSIS;
D O I
10.1161/JAHA.120.021014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Concerns about discordance between echocardiographic and invasive mean gradients after transcatheter aortic valve replacement (TAVR) with balloon-expandable valves (BEVs) versus self-expanding valves (SEVs) exist. Methods and Results In a multicenter study, direct-invasive and echocardiography-derived transvalvular mean gradients obtained before and after TAVR were compared as well as post-TAVR and discharge echocardiographic mean gradients in BEVs versus SEVs in 808 patients. Pre-TAVR, there was good correlation (R=0.614; P<0.0001) between direct-invasive and echocardiography-derived mean gradients and weak correlation (R=0.138; P<0.0001) post-TAVR. Compared with post-TAVR echocardiographic mean gradients, both valves exhibit lower invasive and higher discharge echocardiographic mean gradients. Despite similar invasive mean gradients, a small BEV exhibits higher post-TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post-TAVR and discharge mean gradients. An ejection fraction <50% (P=0.028) and higher Society of Thoracic Surgeons predicted risk of mortality score (P=0.007), but not invasive or echocardiographic mean gradient >= 10 mm Hg (P=0.378 and P=0.341, respectively), nor discharge echocardiographic mean gradient >= 20 mm Hg (P=0.393), were associated with increased 2-year mortality. Conclusions Invasively measured and echocardiography-derived transvalvular mean gradients correlate well in aortic stenosis but weakly post-TAVR. Post-TAVR, echocardiography overestimates transvalvular mean gradients compared with invasive measurements, and poor correlation suggests these modalities cannot be used interchangeably. Moreover, echocardiographic mean gradients are higher on discharge than post-TAVR in all valves. Despite similar invasive mean gradients, a small BEV exhibits higher post-TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post-TAVR and discharge mean gradients. Immediately post-TAVR, elevated echocardiographic-derived mean gradients should be assessed with caution and compared with direct-invasive mean gradients. A low ejection fraction and higher Society of Thoracic Surgeons score, but not elevated mean gradients, are associated with increased 2-year mortality.
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页数:17
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