Echo overestimates trans-aortic gradients immediately post TAVR: A pressure recovery phenomenon in a simultaneous Cath and Echo study

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Journal o the American College of Cardiology


Background Echocardiography (ECHO) is the leading tool to evaluate post TAVR transaortic valve (AV) mean gradients (MG). Pressure recovery (PR) beyond the AV leads to lower and in some cases, markedly discrepant catheterization (CATH) vs. (ECHO) MG in patients with aortic stenosis (AS). We sought to evaluate the effect of PR on post TAVR CATH and ECHO MG.

Methods We retrospectively studied patients undergoing TAVR for severe native AS at our institution from 1/2015-9/2018. Post-TAVR CATH and ECHO MG were obtained simultaneously following implant and compared using the Mann-Whitney U test.

Results 278 patient undergoing TAVR (61 self expanding SE, 217 balloon expanding BE) were included. Mean age of 82 +7 years with 116 (58%) being males. PR evidenced by an ECHO MG > CATH MG was seen in 273 patients (98.2%). There was a significant difference in CATH vs ECHO (median 0 vs 5 respectively, Z = −19.8, p < 0.0001). There was no significant difference between BE and SE valves in regards to their CATH or ECHO MGs. ECHO MG was higher for smaller (20 and 23 mm) vs. larger (26 and 29 mm) BE valves (median 6 mmHg vs. 4 mmHg, respectively p < 0.001) while CATH MGs were similar. However, there was no difference in CATH and ECHO MG between large (29, 31 and 34 mm) and small (23 and 26 mm) SE-TAVR.

Conclusion ECHO MGs were significantly higher than CATH MG post TAVR. In addition, this discordance occurs to a higher degree with smaller BE valves and likely due to PR. This data suggest that ECHO alone may not accurately reflect post TAVR hemodynamics.




9 Supplement

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American College of Cardiology, New Orleans, LA, March 16-18, 2019

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