Does invasive mean transaortic valve gradient measurement predict long-term outcomes better than non-invasive echocardiographic measurement in patients undergoing TAVI?
Invasive mean gradients measured after TAVI are consistently lower than echocardiographic gradients and serve as better predictors of long-term mortality and adverse events.
Transcatheter aortic valve implantation (TAVI) is recommended for treatment of high-risk aortic stenosis patients. While measuring mean transaortic valve gradient (MG) is crucial in evaluating procedural success, echocardiographic measurements often overestimate direct invasive measurements. This study aimed to examine the discordance between echocardiographic and invasive MGs in TAVI patients and assess their prognostic value on long-term outcomes. This prospective registry included consecutive TAVI patients at a tertiary university hospital. Transthoracic or transoesophageal echocardiography was performed pre-TAVI, at discharge, 1 month, 1, and 5 years with invasive MG measurements obtained peri-procedurally. The primary endpoints were 5-year all-cause mortality and major adverse cardiac events. Among 1353 patients from 2011 to 2023, non-invasive MGs exceeded invasive MGs pre- and post-implantation (43 36, 52 mmHg vs. 40 30, 50 mmHg, p 6 mmHg) predicted worse outcomes (mortality hazard: 1.25 1.06, 1.88 and 0.85 0.8, 0.95, respectively), unlike non-invasive measurements. In conclusion, invasive as compared with non-invasive MGs correlated better before than after valve implantation, whereas invasive MGs were always lower than non-invasive MGs. Lower invasive MGs after TAVI appeared to be associated with favourable long-term outcomes.
Pfenniger et al. (Thu,) studied this question.