PMID- 36003692
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220826
IS  - 2666-2736 (Electronic)
IS  - 2666-2736 (Linking)
VI  - 7
DP  - 2021 Sep
TI  - Invasive versus echocardiographic gradients in degenerated surgical aortic valve 
      prostheses: A multicenter study.
PG  - 51-60
LID - 10.1016/j.xjon.2021.06.029 [doi]
AB  - OBJECTIVES: To compare echocardiographic and invasive mean gradients obtained 
      concomitantly in degenerated bioprosthetic surgical aortic valves (SAVRs). 
      METHODS: In a multicenter study, we compared concomitant echocardiographic and 
      invasive mean gradients of SAVR, obtained before valve-in-valve transcatheter 
      aortic valve replacement in all patients, patients with primary stenosis (AS), 
      primary aortic regurgitation (AR), and mixed aortic valve disease (MAVD), and in 
      small versus large valves (</= or >23 mm). Dimensionless index (DI) was calculated 
      in all groups. RESULTS: In total, 74 patients were included and data presented as 
      median (interquartile range). Echocardiography-catheterization mean gradient 
      discordance was observed in all patients (invasive = 22 mm Hg [11-34] vs 
      echocardiographic = 32 mm Hg [21-42], P = .013), small valves (invasive = 15 mm 
      Hg [8-34] vs echocardiographic = 28 mm Hg [21-41], P = .013), and large valves 
      (invasive = 20 mm Hg [8.5-27.13] vs echocardiographic = 32 mm Hg [25.5 - 41.5], 
      P < .0001), with a bias of 8 +/- 15 mm Hg and wide limits of agreement (-22 to 
      39 mm Hg) on Bland-Altman plots, indicating these modalities may not be 
      interchangeable. Discordance occurred in AR (invasive = 3 mm Hg [1-6] vs 
      echocardiographic = 12 mm Hg [7-22], P = .017) and in MAVD (invasive = 19 mm Hg 
      [12-29] vs echocardiographic = 31 mm Hg [23-39], P < .0001) but not in AS 
      (invasive = 35 mm Hg [24-45] vs echocardiographic = 41 mm Hg [30-50], P = .45). A 
      lower DI (0.21 [0.14-0.25]) occurred in AS compared with MAVD (0.31 [0.19-0.39]) 
      and AR (0.55 [0.51-0.69]), P < .0001. CONCLUSIONS: Discordance between 
      echocardiography and invasive mean gradients exists in degenerated SAVR, 
      regardless of valve size, but depends on mechanism of failure and DI helps 
      stratify these patients. With a discrepancy between echocardiographic mean 
      gradients AND the patient's symptoms OR the valve leaflet structure and/or 
      mobility on imaging, especially before redo-SAVR or valve-in-valve transcatheter 
      aortic valve replacement, invasive gradients may adjudicate the true valvular 
      hemodynamics.
CI  - (c) 2021 The Authors.
FAU - Kadri, Amer N
AU  - Kadri AN
AD  - Division of Cardiology, Beaumont Health, Dearborn, Mich.
FAU - Hanzel, George
AU  - Hanzel G
AD  - Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Mich.
AD  - Oakland University William Beaumont School of Medicine, Auburn Hills, Mich.
FAU - Elmariah, Sammy
AU  - Elmariah S
AD  - Division of Cardiology, Massachusetts General Hospital, Boston, Mass.
FAU - Shannon, Francis
AU  - Shannon F
AD  - Oakland University William Beaumont School of Medicine, Auburn Hills, Mich.
AD  - Division of Cardiovascular Surgery, Beaumont Hospital, Royal Oak, Mich.
FAU - Al-Azizi, Karim
AU  - Al-Azizi K
AD  - Division of Cardiology, The Heart Hospital Baylor Plano, Plano, Tex.
FAU - Boura, Judith
AU  - Boura J
AD  - Department of General Medical Education, Ascension-Macomb Oakland Hospital, 
      Warren, Mich.
FAU - Mack, Michael
AU  - Mack M
AD  - Division of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Tex.
FAU - Abbas, Amr E
AU  - Abbas AE
AD  - Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Mich.
AD  - Oakland University William Beaumont School of Medicine, Auburn Hills, Mich.
LA  - eng
PT  - Journal Article
DEP - 20210717
PL  - Netherlands
TA  - JTCVS Open
JT  - JTCVS open
JID - 101768541
PMC - PMC9390586
OTO - NOTNLM
OT  - AR, aortic regurgitation
OT  - AS, aortic stenosis
OT  - AV, aortic valve
OT  - AVA, aortic valve area
OT  - DI, dimensionless index
OT  - IQR, interquartile range
OT  - LV, left ventricle
OT  - LVOT, left ventricular outflow tract
OT  - MAVD, mixed aortic valve disease
OT  - SAVR
OT  - SAVR, surgical aortic valve replacement
OT  - TAVR, transcatheter aortic valve replacement
OT  - TVI, time velocity integral
OT  - ViV, valve-in-valve
OT  - degenerated bioprosthetic valves
OT  - discordance
OT  - echocardiography
OT  - hemodynamics
EDAT- 2022/08/26 06:00
MHDA- 2022/08/26 06:01
PMCR- 2021/07/17
CRDT- 2022/08/25 02:24
PHST- 2020/12/15 00:00 [received]
PHST- 2021/06/04 00:00 [accepted]
PHST- 2022/08/25 02:24 [entrez]
PHST- 2022/08/26 06:00 [pubmed]
PHST- 2022/08/26 06:01 [medline]
PHST- 2021/07/17 00:00 [pmc-release]
AID - S2666-2736(21)00189-3 [pii]
AID - 10.1016/j.xjon.2021.06.029 [doi]
PST - epublish
SO  - JTCVS Open. 2021 Jul 17;7:51-60. doi: 10.1016/j.xjon.2021.06.029. eCollection 
      2021 Sep.