Transvalvular Pressure Gradients and All-Cause Mortality Following TAVR: A Multicenter Echocardiographic and Invasive Registry
- PMID: 36137687
- DOI: 10.1016/j.jcin.2022.07.033
Transvalvular Pressure Gradients and All-Cause Mortality Following TAVR: A Multicenter Echocardiographic and Invasive Registry
Abstract
Background: Low ejection fraction (EF) and low flow as determined by an echocardiographic stroke volume index (SVi) <35 mL/m2 are associated with low transvalvular gradients and increased mortality in both severe aortic stenosis (AS) and post-transcatheter aortic valve replacement (TAVR). Absence of an elevated echocardiographic transaortic gradient post-TAVR is considered a marker of procedural success despite the absence of data on its impact on mortality.
Objectives: The authors sought to examine the association of invasive and echocardiographic gradients post-TAVR with all-cause mortality in relation to flow and EF.
Methods: In a multicenter retrospective registry of patients undergoing TAVR, Cox models with regression splines explored the relationship between invasive and echocardiographic gradients post-TAVR with 2-year mortality. An invasive gradient <5 mm Hg was considered low, between ≥5 and <10 mm Hg was considered intermediate, and ≥10 mm Hg was considered high. An echocardiographic gradient <10 mm Hg was considered low, ≥10 and <20 mm Hg was considered intermediate, and ≥20 mm Hg was considered high.
Results: Higher mortality occurred in low echocardiographic gradients at discharge relative to intermediate gradients (P < 0.001), and low gradient was associated with lower EF and echocardiographic SVi (P < 0.001 and P < 0.008, respectively). Lower mortality occurred in low invasive gradients relative to intermediate gradients (P = 0.012) with no difference in EF and echocardiographic SVi between groups (P = 0.089 and P = 0.947, respectively). There were insufficient observations to determine the impact of high echocardiographic and invasive gradients on mortality.
Conclusions: In this large retrospective analysis, the impact of transaortic gradients on mortality after TAVR was not linear and complex, showing opposite results among echocardiographic and invasive measurements in low-gradient patients.
Keywords: Bernoulli; discordance; echocardiography; gradients; invasive; pressure recovery.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Khalili has received a research grant from Edwards Lifesciences; and speaker fees from Abbott Vascular. Dr Pibarot has received research grants and consulting fees from Edwards Lifesciences; and has received grants from Medtronic. Dr Hahn has received speaker fees from Boston Scientific, Edwards Lifesciences, and Medtronic; and has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Gore & Associates, Medtronic, and Philips Healthcare. Dr Elmariah has received research grants and consulting fees from Edwards Lifesciences; and has received research grants from Medtronic. Dr Pilgrim has received grants from Boston Scientific; has received speaker fees from Biotronik; is a consultant for HighLife SAS; and is a proctor for Boston Scientific and Medtronic. Dr Okuno has received speaker fees from Abbott. Dr Mack has received research grants and consulting fees from Edwards Lifesciences. Dr Abbas has received research grants and consulting fees from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Comment in
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Measuring Transvalvular Aortic Pressure Gradients: Answering Questions or Asking New Ones?JACC Cardiovasc Interv. 2022 Sep 26;15(18):1849-1851. doi: 10.1016/j.jcin.2022.08.021. JACC Cardiovasc Interv. 2022. PMID: 36137688 No abstract available.
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