Transvalvular Pressure Gradients and All-Cause Mortality Following TAVR: A Multicenter Echocardiographic and Invasive...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Low ejection fraction (EF) and low stroke volume index (SVi) are linked to low transvalvular gradients and increased mortality in severe aortic stenosis (AS) and post-transcatheter aortic valve replacement (TAVR).
• Absence of an elevated echocardiographic transaortic gradient post-TAVR is often seen as a marker of procedural success, but its impact on mortality is not well-established.

Purpose of the Study:

• To investigate the association between invasive and echocardiographic gradients post-TAVR and all-cause mortality.
• To analyze these associations in relation to cardiac flow and ejection fraction (EF).

Main Methods:

• A multicenter retrospective registry of patients undergoing TAVR was analyzed.
• Cox models with regression splines were used to assess the relationship between gradients and 2-year mortality.
• Gradients were categorized as low, intermediate, or high based on both invasive and echocardiographic measurements.

Main Results:

• Higher mortality was observed with low echocardiographic gradients compared to intermediate gradients (P < 0.001), associated with lower EF and SVi.
• Lower mortality was observed with low invasive gradients compared to intermediate gradients (P = 0.012), with no significant differences in EF or SVi.
• Insufficient data were available to assess the impact of high echocardiographic and invasive gradients on mortality.

Conclusions:

• The impact of transaortic gradients on mortality after TAVR is non-linear and complex.
• Echocardiographic and invasive gradient measurements yield contrasting results regarding mortality in low-gradient TAVR patients.