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.
Cohort (n=1,589)
No
Does transthoracic echocardiography accurately correlate with invasive pressure gradients in patients immediately following transcatheter aortic valve implantation?
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.
Effect estimate: Spearman ρ = 0.401 (95% CI 0.360–0.440)
p-value: p=<0.001
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.
Brown et al. (Fri,) 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.