Author + information
- Zaher Fanaria,b,
- Prasad Gunasekarana,b,
- Jhapat Thapaa,b,
- Arslan Shaukata,b,
- Kamleish Persada,b,
- Sumaya Hammamia,b,
- Mark Wileya,b,
- Buddhadeb Dawna,b,
- Joseph Westa,b,
- William Weintrauba,b,
- Andrew Dooreya,b and
- Peter Tadrosa,b
Background: Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable discrepancies between echo and catheterization (cath) lab measurements. We wanted to investigate the impact of both transaortic gradient and flow on this discrepancy.
Methods: 297 patients with Severe AS with AVA <1 cm2 by echo aged 61-94 underwent right and left heart cath with gradient assessed through simultaneous left ventricular (St. Jude) pressure wire recording of left ventricular pressure and fluid filled pressure catheter recording of aortic pressure measured > 5 cm above the valve. Patients were classified based on echocardiography gradient to either High gradient (HG ≥ 40 mmHg) or low gradient (LG < 40 mmHg). Similarly patients were classified depending on their SVI to either low flow (LF < 35 ml/m2))or normal flow (NF ≥35 ml/m2).
Results: Of 297 patients there was 98 with HG and 1799 with LG. As for flow there was 159 with LF and 138 with NF. The discrepancy between echocardiography and cardiac catherization assessment was very limited in patients with high gradient when compared to those with low gradient (6% vs. 24%; P= 0.02). The discrepancy was witnessed equally in both low flow and normal flow patients (18.3% vs. 17.6%; P=0.89). No clinical strokes or TIA were observed in the 30 days after cardiac catheterizations.
Conclusions: While echocardiography is very predictive of the severity of AS in patients with high gradient, it is very limited in discriminating patients with low gradient. The flow through the valve did not impact predictability of stenosis. Invasive hemodynamic assessment can be beneficial in patients with low gradient aortic stenosis.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: Structural Heart Disease
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1241-146
- 2017 American College of Cardiology Foundation