Discrepancies between direct catheter and echocardiography-based values in aortic stenosis

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.