Invasive Versus Echocardiographic Evaluation of Transvalvular Gradients Immediately Post TAVR: Demonstration of Significant Echocardiography-Catheterization Discordance

Abbas, Amr

Invasive Versus Echocardiographic Evaluation of Transvalvular Gradients Immediately Post TAVR: Demonstration of Significant Echocardiography-Catheterization Discordance

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Amr E Abbas md, M.D., FSCAI , William Beaumont Hospital, Berkley, MI

Ramy Mando, M.D. , Beaumont Health, Royal Oak, MI

George S. Hanzel, M.D., FSCAI , William Beaumont Hospital, Bloomfield Hills, MI

Philippe Pibarot, DVM, Ph.D , Laval University, Quebec, QC, Canada

Francis Shannon, M.D. , William Beaumont Hospital, Royal Oak, MI

Michael Gallagher , William Beaumont Hospital, Royal Oak, MI

Robert D. Safian, M.D., FSCAI , William Beaumont Hospital, Royal Oak, MI

Background:
Elevated post TAVR ECHO MGs, despite normal valve function are reported but do not correlate with outcomes. Pressure recovery (PR) causes a discrepancy between ECHO and CATH MGs and has not been evaluated post TAVR and may explain this finding. We compared the immediate post TAVR ECHO and CATH MGs to determine ECHO/CATH discordance and degree of PR.

Methods:
Post TAVR ECHO and CATH MG data obtained almost simultaneously were compared using the Mann Whitney test in consecutive patients undergoing TAVR.

Results:
314 patients underwent TAVR, 278 for native valve AS (NV) and 36 for valve in valve (ViV) TAVR. ECHO MG was significantly > CATH MG in 305/314 (97%). (Median 5, range 1-40 mmHg Vs. median 0, range 0-37 mmHg, respectively, p < 0.0000001, Z =-19.48) regardless of valve indication, type, or size. Discordance was ≥5 mmHg in 48% of patients especially with ViV and small balloon expandable (BE) TAVR.

Conclusions:
ECHO and CATH MG discordance occurs in almost all patients post TAVR. ECHO measurements should not be solely relied upon and CATH MG should be documented in all cases.