Key result
TTE gradients correlate moderately with invasive gradients post-TAVI with median discordance of ~2 mmHg.
Why the study?
Evidence regarding the reliability of TTE in assessing valvular gradients immediately following TAVI remains conflicting.
Does transthoracic echocardiography accurately correlate with invasive pressure gradients in patients immediately following transcatheter aortic valve implantation?
Cohort (n=1,589)
No
Does transthoracic echocardiography accurately correlate with invasive pressure gradients in patients immediately following transcatheter aortic valve implantation?
Effect estimate: Spearman ρ = 0.401 (95% CI 0.360–0.440)
p-value: p=<0.001
Transthoracic echocardiography demonstrates a moderate correlation with invasive measurements for assessing transvalvular pressure gradients immediately after TAVI, with modest discordance that does not significantly impact long-term survival.
Rare >10 mmHg post-TAVI TTE-invasive discordance lacks survival impact; supports echocardiography for immediate assessment while hypothesis-generating for outliers.
Background: Evidence regarding the reliability of transthoracic echocardiography (TTE) in assessing valvular gradients immediately following transcatheter aortic valve implantation (TAVI) remains conflicting. Thus, this study aimed to compare post-procedural TTE and invasive mean aortic valve (AV) pressure gradients immediately after TAVI. Methods: This was a retrospective, single-institution cohort study of consecutive TAVIs between 2012 and 2023. Immediate post-procedural mean AV pressure gradients were measured invasively via pigtail catheter and non-invasively via TTE. The Spearman coefficient was used to assess the correlation between TTE and invasive gradients. Multivariable Cox proportional-hazards regression was performed for long-term survival. Results: A total of 1589 patients underwent TAVI with available TTE and invasive pressure gradients. A total of 49.2% received self-expanding valves (SEVs), and 50.8% received balloon-expanding valves (BEVs); 7.2% underwent valve-in-valve (ViV); 17.6% received a small valve (Evolut ≤26 mm, Sapien ≤23 mm, and Portico/Navitor ≤25 mm). For the entire cohort, the TTE and invasive mean gradients showed a moderate correlation (Spearman ρ = 0.401), with a median absolute difference of 2.2 [1.0–4.0] mmHg. The SEV gradients were more strongly correlated than the BEV gradients (ρ = 0.447 vs. 0.345). Similarly, the small valve gradients were more strongly correlated than the large valve gradients (ρ = 0.455 vs. 0.375), while the ViV gradients were more strongly correlated than the native TAVI gradients (ρ = 0.575 vs. 0.357). A total of 1.6% of the patients had a difference >10 mmHg between the invasive and TTE gradients. In the multivariable Cox regression, a >10 mmHg discordance was not significantly associated with an increased hazard of death after TAVI (p = 0.326). Conclusions: Following TAVI, we observed a moderate correlation between TTE and invasive measurements of mean AV pressure gradients, with only modest discordance noted between measurement modalities.
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Brown et al. (2026) conducted a cohort in Patients undergoing transcatheter aortic valve implantation with immediate post-procedural invasive and transthoracic echocardiographic mean aortic valve pressure gradient measurements (n=1,589). Transthoracic echocardiography (TTE) gradient measurement vs. invasive catheter measurement was evaluated on Correlation between post-procedural TTE and invasive mean aortic valve pressure gradient measurements immediately after TAVI (Spearman ρ = 0.401, 95% CI 0.360–0.440, p=<0.001). Transthoracic echocardiography gradients showed moderate correlation with invasive mean aortic valve pressure gradients immediately post-TAVI (Spearman ρ = 0.401) with median discordance of 2.2 mmHg.
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