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Published on: February 20, 2017
Discrepancies between direct catheter and echocardiography-based values in aortic stenosis
Chia-Shing Yang1, Erik S Marshall2, Zaher Fanari2
1Department of Medicine, Christiana Care Health System, Newark, DE.
Insights
Cardiac catheterization and echocardiography show lower correlation for aortic stenosis severity than expected, potentially impacting surgical decisions. Relying solely on echocardiography may be problematic.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Echocardiography (echo) is preferred for aortic stenosis (AS) assessment, but invasive pressure measurements via cardiac catheterization (CCL) are sometimes necessary.
- Previous studies reported high correlation between echo and CCL for AS severity, but current practice may differ.
Purpose of the Study:
- To evaluate the correlation between catheter-based and echocardiographic assessments of AS severity.
- To determine if discrepancies impact surgical referral decisions in a community-based academic hospital.
Main Methods:
- 40 patients with suspected AS underwent catheterization with pressure gradient measurements.
- Echocardiograms were independently reviewed by experts to assess initial interpretation quality.
Main Results:
- Catheterization altered aortic valve area (AVA) assessment by >0.3 cm² in 25% and >0.5 cm² in 8% of patients.
- 30% of patients had their AVA reclassified across the surgical threshold (<1 cm²).
- Pearson correlation between echo and CCL AVA measurements was 0.35, significantly lower than prior reports. Expert review minimally improved correlation (0.46).
Conclusions:
- The correlation between catheterization and echocardiography for AS severity is lower in current practice than previously assumed.
- Discrepancies can influence decisions regarding aortic valve replacement surgery.
- Sole reliance on echocardiography for AS assessment may be unreliable.
Objectives:
The goal of this article is to examine the correlation of catheter (cath) based and echocardiographic assessment of aortic stenosis (AS) in a community-based academic hospital setting, particularly in the degree that decision to refer for surgery is altered.
Background:
Current guidelines discourage AS evaluation by invasive pressure measurement if echocardiography (echo) is adequate, but several studies show sizable differences between echo and cardiac catheterization lab (CCL) measurements. We examine this correlation using high quality CCL techniques.
Methods:
Sequential patients with suspected AS by echo (n = 40) aged 61-94 underwent catheterization with pressure gradients via left ventricular pressure wire and ascending aorta catheter. The echos leading to the catheterization were independently reviewed by an expert panel to assess the quality of community-based readings.
Results:
CCL changed assessment of severity of aortic valve area (AVA) by more than 0.3 cm(2) in 25% and 0.5 cm(2) in 8%. Values changed to over or under the surgical threshold of AVA < 1 cm(2) in 30% of the patients. Pearson correlation of 0.35 between measurements of AVA by echo and CCL is lower than earlier studies, which often reported correlation values of 0.90 or greater. Echo expert reviews provided minimal improvement in discrepancies (Pearson correlation of 0.46), suggesting quality of initial interpretation was not the issue.
Conclusions:
Cath-echo correlation of AS severity is lower in contemporaneous practice than previously assumed. This can alter the decision for aortic valve replacement. Sole reliance on echo-derived assessment of AS may at times be problematic.
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