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

Houman Khalili, Philippe Pibarot, Rebecca T. Hahn, Sammy Elmariah, Thomas Pilgrim, Anthony A. Bavry, Brijeshwar Maini, Taishi Okuno, Karim Al-Azizi, Thomas E. Waggoner, Michael Mack, Joseph Rodès-Cabau, Amr E. Abbas

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Low ejection fraction (EF) and low flow as determined by an echocardiographic stroke volume index (SVi) <35 mL/m2 are associated with low transvalvular gradients and increased mortality in both severe aortic stenosis (AS) and post–transcatheter aortic valve replacement (TAVR). Absence of an elevated echocardiographic transaortic gradient post-TAVR is considered a marker of procedural success despite the absence of data on its impact on mortality. Objectives: The authors sought to examine the association of invasive and echocardiographic gradients post-TAVR with all-cause mortality in relation to flow and EF. Methods: In a multicenter retrospective registry of patients undergoing TAVR, Cox models with regression splines explored the relationship between invasive and echocardiographic gradients post-TAVR with 2-year mortality. An invasive gradient <5 mm Hg was considered low, between ≥5 and <10 mm Hg was considered intermediate, and ≥10 mm Hg was considered high. An echocardiographic gradient <10 mm Hg was considered low, ≥10 and <20 mm Hg was considered intermediate, and ≥20 mm Hg was considered high. Results: Higher mortality occurred in low echocardiographic gradients at discharge relative to intermediate gradients (P < 0.001), and low gradient was associated with lower EF and echocardiographic SVi (P < 0.001 and P < 0.008, respectively). Lower mortality occurred in low invasive gradients relative to intermediate gradients (P = 0.012) with no difference in EF and echocardiographic SVi between groups (P = 0.089 and P = 0.947, respectively). There were insufficient observations to determine the impact of high echocardiographic and invasive gradients on mortality. Conclusions: In this large retrospective analysis, the impact of transaortic gradients on mortality after TAVR was not linear and complex, showing opposite results among echocardiographic and invasive measurements in low-gradient patients.

Original languageEnglish (US)
Pages (from-to)1837-1848
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume15
Issue number18
DOIs
StatePublished - Sep 26 2022

Keywords

  • Bernoulli
  • discordance
  • echocardiography
  • gradients
  • invasive
  • pressure recovery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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