Author + information
- S1936879815022414-8cefe0d5774f50532cdf1fc1d21172b3Zaher Fanari1,
- S1936879815022414-ac0d46527e9911449140e4847575cbe7Jhapat Thapa2,
- S1936879815022414-3ab1936fd88cd593d31b70839d49d1cbKamleish Persad1,
- S1936879815022414-4da21c14bede91df01a85d905361bc77Sumaya Hammami1,
- S1936879815022414-d85e5bef732a058cde7738e39e6a5e22Michael Kostal2,
- S1936879815022414-23693b82fb4600e7a176382fad6482b7Joseph West2,
- S1936879815022414-ec58f8bc14599f51abb2124998e67e4fErik Marshall2,
- S1936879815022414-ab548ce214d93899ef4f84c100dbd2feWilliam S. Weintraub2 and
- S1936879815022414-6f3bdc6adf26038f1a66378946357a02Andrew Doorey2
Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable differences between echo and catheterization (cath) lab measurements. Low flow/ low gradient (LF/LG) severe aortic stenosis (AS) with preserved EF constitutes a real challenge with no clear method to confirm the severity of AS in this group. Normal flow/ low gradient AS with preserved EF is considered as echocardiography miscalculation by guidelines. Using pressure wire for aortic stenosis assessment may offer a safe and higher quality technique to assess the severity of AS in LF/LG and NF/LG AS with preserved EF.
104 Sequential patients with AVA 50% underwent right and left heart cath by two operators with pressure gradients via left ventricular (St. Jude) pressure wire and ascending aorta catheter. Of these, there were 57 with high gradient (HG), 33 with LF/LG and 14 with NF/LG. Cath derived values were based on simultaneous pressure wire recording of left ventricular pressure and fluid filled pressure catheter recording of aortic pressure measured > 5 cm above the valve. Cardiac output was calculated by thermodilution.
While the classification of severe AS by cath and echocardiography was concordant in 96% of HG AS patients (55/57), there was large discrepancy of this classification in patients with LF/LG and NF/LG. Severe AS was confirmed with cardiac in 67% of LF/LG patients (22/33) and 43% of those with NF/LG (6/14). No clinical strokes or TIA were observed in the 30 days after procedure in any of the patients.
Invasive hemodynamic assessment of AS can be beneficial in identifying true severe AS in patients with LF/LG and NF/LG severe AS with preserved EF.