Author + information
- Islam Abdelkarim,
- Jeffrey Xu,
- Michael Sharbaugh,
- Andrew Althouse,
- William Katz,
- Frederick Crock,
- Matthew Harinstein,
- Dustin Kliner,
- Forozan Navid,
- Joon Lee,
- John Schindler,
- Thomas Gleason and
- Joao L. Cavalcante
Background: Pulmonary hypertension (PH) is common and prognostically important in patients undergoing transcatheter aortic valve replacement (TAVR). However, the accuracy of PH severity assessment by transthoracic echocardiogram (TTE) when compared to gold standard right heart catheterization (RHC) is currently unknown in these patients.
Methods: Patients being evaluated for TAVR who underwent TTE and RHC within 3 days. PH severity was classified as none, mild, moderate, and severe using the following PASP cutoffs: <35, 35-45, 46-59 and ≥ 60 mmHg, respectively. Weighted κ statistics evaluated PH severity agreement. Bland-Altman plots and linear regression correlated PASP between 2 methods.
Results: 86 patients with severe AS were identified. Mean age 84±6 years, indexed AV area=0.33±0.1 cm2/m2, LVEF=51±15%, PASP=45±20 mmHg. Although linear correlation of PASP between RHC and TTE was modest (r=0.64, p <0.001, Panel A), PH severity agreement was poor (κ = 0.34, Panel B). Out of 51/86 patients with no/mild PH by TTE, 25/51 (49%) were reclassified to >= moderate PH by RHC with 10/51 (20%) as severe PH by RHC. TTE was very specific for severe PH screening (0.96, 95% CI 0.87-0.99) but not adequately sensitive (0.47, 95% CI 0.29-0.65).
Conclusions: Modest agreement exists between TTE vs. RHC for PH severity assessment with 1/5 patients reclassified to severe PH by RHC. Accurate PH assessment is critically important and RHC performance should be considered in adjunction to coronary angiography in TAVR patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Challenges of Outcome Prediction in Valvular Heart Disease
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1274-030
- 2017 American College of Cardiology Foundation