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Comparison of Echocardiography and Invasive Transseptal Catheterization for Assessing Transvalvular Gradient in
Ahmet Hakan Ates1, Ahmet Kivrak1, Ugur Canpolat1
1Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
Insights
Echocardiography measurements of transvalvular gradients (TVGs) in aortic valve prostheses were significantly higher than invasive measurements. Invasive confirmation may be considered for selected patients with moderate-to-severe TVGs identified by echocardiography.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Echocardiography is the standard for monitoring aortic valve prostheses.
- Concerns exist regarding the accuracy of echocardiography compared to invasive measurements of transvalvular gradients (TVGs).
Purpose of the Study:
- To compare TVGs in aortic valve prostheses using both noninvasive echocardiography and invasive catheterization.
- To assess the consistency between echocardiographic and invasive gradient measurements.
Main Methods:
- Included 14 patients with metallic or bioprosthetic aortic valve replacements and moderate-to-severe TVGs on echocardiography.
- Performed invasive transseptal catheterization to measure gradients and compared results with echocardiographic data.
- Analyzed correlations between echocardiographic valve area indices and invasive gradients.
Main Results:
- Echocardiographic maximum TVGs were significantly higher than invasive peak-to-peak TVGs (77.0 ± 13.1 vs. 47.5 ± 21.7 mmHg).
- Significant negative correlations were found between echocardiographic valve area indices and invasive gradients.
- An effective orifice area index (EOAI) < 0.50 cm²/m² predicted severe invasive gradients, leading to redo surgery in 42.9% of cases.
Conclusions:
- Echocardiography may overestimate TVGs in aortic valve prostheses compared to invasive measurements.
- Invasive assessment could be beneficial for selected patients with echocardiographically determined moderate-to-severe TVGs.
Abstract:
Background: Echocardiography is the primary assessment tool for follow-up in patients with aortic valve prostheses. However, there are concerns regarding the consistency between echocardiographic and invasive transvalvular gradients (TVGs). This study utilized both noninvasive and invasive methods to compare the TVGs in aortic valve prostheses. Methods: The study included fourteen patients who had previously undergone surgical aortic valve replacement [metallic (n = 12) and bioprosthetic (n = 2)]. All patients had moderate-to-severe TVGs, which were measured during follow-up echocardiography, and they underwent invasive transseptal catheterization. Invasive and echocardiographic TVGs were measured and compared. Results: The median interval between index valvular surgery and invasive TVG measurement was 6.7 (2.5-11.5) years. The median interval between echocardiographic and invasive TVG measurements was 7.2 (2-19) days. Only 12 (85.7%) patients were symptomatic during echocardiographic assessment. Maximum TVGs obtained by echocardiography were higher than invasive peak-to-peak TVGs (77.0 ± 13.1 vs. 47.5 ± 21.7 mmHg, p < 0.05). There was a significant negative correlation between the echocardiography-based aortic valve area and the effective orifice area index with the catheter-based peak-to-peak aortic gradient (r = -0.64, p = 0.014 and r = -0.63, p = 0.015). Six patients (42.9%) who revealed severe catheter-based peak-to-peak aortic gradient underwent redo aortic valve surgeries. The cut-off value of EOAI of <0.50 cm2/m2 was found to be a predictor of severe catheter-based peak-to-peak aortic gradient. Conclusions: In our preliminary cohort study, the TVGs of aortic valvular prostheses measured by echocardiography were significantly greater than those measured by invasive transseptal catheterization. During follow-up, invasive confirmation of echocardiographic moderate-to-severe TVGs in selected patients with surgical aortic valvular prostheses may be considered.
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