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

Author:

Abbas Amr E.12ORCID,Mando Ramy1ORCID,Kadri Amer1,Khalili Houman3,Hanzel George12,Shannon Francis12,Al‐Azizi Karim4,Waggoner Thomas5,Kassas Safwan6,Pilgrim Thomas7ORCID,Okuno Taishi7,Camacho Alexander8ORCID,Selberg Alexandra8ORCID,Elmariah Sammy8ORCID,Bavry Anthony9ORCID,Ternacle Julien10ORCID,Christensen Jared4ORCID,Gheewala Neil5,Pibarot Philippe10ORCID,Mack Michael4ORCID

Affiliation:

1. Beaumont Hospital Royal Oak Royal Oak MI

2. Oakland University William Beaumont School of Medicine Auburn Hills MI

3. Delray Medical Center Delray Beach FL

4. The Heart Hospital Baylor Plano Plano TX

5. Pima Heart and Vascular Tucson Medical Center Tucson AZ

6. Ascension St. Mary's Hospital Saginaw MI

7. Bern University Hospital Bern Switzerland

8. Massachusetts General Hospital Boston MA

9. University of Florida Gainesville FL

10. Université Laval/Québec Heart and Lung Institute Québec Canada

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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