Key result
Likely severe discordant AS is linked to ~60% lower 5-year post-TAVI cardiac mortality versus unlikely severe AS.
Why the study?
Data are limited on the diagnostic role of invasively measured transvalvular flow rate in patients with low-gradient severe aortic stenosis and preserved LVEF before TAVI.
Does invasively measured transvalvular flow rate predict likely severe aortic valve stenosis and 5-year cardiac mortality in patients with low-gradient severe AS and normal LVEF?
Observational (n=134)
No
Does invasively measured transvalvular flow rate predict likely severe aortic valve stenosis and 5-year cardiac mortality in patients with low-gradient severe AS and normal LVEF?
Hazard Ratio: 0.4 (95% CI 0.17–0.95)
p-value: p=0.038
Invasively measured transvalvular flow rate ≤ 200 ml/s is strongly associated with likely severe AS and predicts 5-year cardiac mortality after TAVI in patients with low-gradient AS and normal LVEF.
May refine low-gradient severe AS diagnosis; hypothesis-generating for mortality prediction, requires prospective validation.
Background There are limited data on the diagnostic role of invasively measured transvalvular flow rate (TFR) in patients with low-gradient (mean gradient < 40 mmHg) severe aortic valve stenosis (AS) (aortic valve area (AVA) ≤ 1 cm2) before transcatheter aortic valve implantation (TAVI). Objectives To evaluate the role of invasively measured TFR as a diagnostic tool for likely severe discordant AS in patients with preserved left ventricular ejection fraction (LVEF). Methods We included 134 patients from a single-center registry, who had low-gradient, severe AS, and normal LVEF, and underwent pre-TAVI invasive hemodynamic evaluation. Patients were divided into likely and unlikely severe AS according to the latest European Society of Cardiology (ESC) guidelines. Results Patients with likely and unlikely severe AS had comparable stroke volume index (SVi) (32.01 ± 9.15 vs. 34.09 ± 11.36 ml/m2, p = 0.536), while the likely severe AS group had a lower TFR (159 ± 51.03 vs. 180 ± 56.03 ml/s, p = 0.044). We found that 77.3% of patients with a SVi > 35 ml/m2 had TFR ≤ 200 ml/s. Patients with likely severe AS showed lower 5-year cardiac mortality compared with unlikely severe AS after TAVI (adj. HR 0.40; 95% CI 0.17–0.95, p = 0.038), and comparable to high-gradient severe AS (21.3% vs. 26.2%, log rank, p = 0.847). TFR ≤ 200 ml/s was highly associated with the diagnosis of likely severe AS (adj. OR 3.09; 95% CI 1.30–7.34, p = 0.010). Integrating TFR into the diagnostic criteria for severe AS could predict 5-year cardiac mortality (adj. HR 0.45; 95% CI 0.21–0.97, p = 0.042), unlike SVi. Conclusion Low invasive TFR is highly associated with the diagnosis of likely severe AS. Likely severe discordant AS with normal LV systolic function showed better long-term outcome after TAVI.
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Elbasha et al. (2026) conducted an observational in Low-gradient severe aortic valve stenosis with normal LVEF (n=134). Likely severe aortic stenosis vs. Unlikely severe aortic stenosis was evaluated on 5-year cardiac mortality (HR 0.40, 95% CI 0.17-0.95, p=0.038). Likely severe discordant aortic stenosis with normal LV systolic function was associated with lower 5-year cardiac mortality after TAVI compared to unlikely severe AS (HR 0.40; 95% CI 0.17-0.95).
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