Comparisons of Echocardiographic and Invasive Aortic Gradient Assessment in Aortic Stenosis, Degenerated Surgical Bioprosthesis, Native and Valve-In-Valve Tavr: A Multicenter Study
Journal of the American College of Cardiology
Discordance between echo and invasive assessment of aortic valve gradient has been reported. We sought to compare the two modalities across a spectrum of conditions: native aortic stenosis (AS), structural valve deterioration (SVD) of surgical bioprostheses, post-native and valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR).
Data on 5,192 patients were collected from 9 institutions. The degree of association and magnitude of discordance between concomitant echo and invasive gradients were compared.
There was moderate correlation between echo and invasive gradients in native AS (r = 0.69) with good agreement (Bias -0.11; 95% Confidence Interval (CI): -0.4 - 0.62), moderate correlation in SVD (r = 0.56) with good agreement (Bias 1.08; 95% CI: -2.43 - 4.59), moderate correlation in ViV (r = 0.61) with poor agreement (Bias 6.47; 95% CI: 5.08 - 7.85), and weak correlation in native TAVR (r = 0.18) with poor agreement (Bias 3.41; 95% CI: 3.16 - 3.65). The magnitude of percent discordance was 1.3% for native AS, 4.0% for SVD, 66.67% for ViV, and 100.0% for native TAVR. Magnitude of discordance was only similar between AS and SVD (p = 0.143).
Discordance between echo and invasive gradients depends on clinical scenario. There is a higher correlation and agreement in the presence of native AS or SVD compared to a weaker correlation and agreement in normal TAVR valves. The measurement of high gradient by echo at the time of TAVR should be confirmed by invasive measure.
Khalili H, Abbas A, Pilgrim T, Okuno T, Elmariah S, Al-Azizi K, Hanzel G, Waggoner T, Mando R, Bavry A, Pibarot P. Comparisons of Echocardiographic and Invasive Aortic Gradient Assessment in Aortic Stenosis, Degenerated Surgical Bioprosthesis, Native and Valve-In-Valve Tavr: A Multicenter Study. Journal of the American College of Cardiology. 2021 May 11;77(18_Supplement_1):917.