Author + information
- Zaher Fanaria,b,
- Prasad Gunasekarana,b,
- Arslan Shaukata,b,
- Jhapat Thapaa,b,
- Kamleish Persada,b,
- Sumaya Hammamia,b,
- Joseph Westa,b,
- Mark Wileya,b,
- Buddhadeb Dawna,b,
- William Weintrauba,b,
- Peter Tadrosa,b and
- Andrew J. Dooreya,b
Background: Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable differences between echo and catheterization (cath) lab measurements. Low flow/ low gradient (LF/LG) severe aortic stenosis (AS) with preserved EF constitutes a real challenge with no clear method to confirm the severity of AS in this group. Normal flow/ low gradient AS with preserved EF is considered as echocardiography miscalculation by guidelines. Using pressure wire for aortic stenosis assessment may offer a safe and higher quality technique to assess the severity of AS in LF/LG and NF/LG AS with preserved EF.
Methods: 297 Sequential patients with AVA < 1cm 2 on echocardiography underwent right and left heart cath by two operators with pressure gradients via left ventricular (St. Jude) pressure wire and ascending aorta catheter. Of these, there were 95 with high gradient (HG), 117 with LF/LG and 67 with NF/LG. Cath derived values were based on simultaneous pressure wire recording of left ventricular pressure and fluid filled pressure catheter recording of aortic pressure measured > 5 cm above the valve. Cardiac output was calculated by thermodilution.
Results: Of 297 patients there was 98 with HG AS, 117 with LF/LG and 67 with NF/LG. While the classification of severe AS by cath and echocardiography was concordant in 94% of HG AS patients (92/98), there was large discrepancy of this classification in patients with LF/LG and NF/LG. Severe AS was confirmed with cardiac in 77% of LF/LG patients (90/117) and 70% of those with NF/LG (47/67). No clinical strokes or TIA were observed in the 30 days after procedure in any of the patients.
Conclusions: Invasive hemodynamic assessment of AS can be beneficial and provide better discrimination to Echocardiography in identifying true severe in patients with LF/LG and NF/ LG severe AS with preserved EF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: PCI and TAVR in Complex Patients
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1239-124
- 2017 American College of Cardiology Foundation