Abstract ▼ AI-Helper

Aims: Adjustment for pressure recovery (PR) may reconcile discrepancies in pressure gradient measured by Doppler echocardiography and direct catheterization in patients with mild to moderately severe aortic stenosis (AS). We tested whether PR adjustment is useful in a large cohort of patients with p...

Aims: Adjustment for pressure recovery (PR) may reconcile discrepancies in pressure gradient measured by Doppler echocardiography and direct catheterization in patients with mild to moderately severe aortic stenosis (AS). We tested whether PR adjustment is useful in a large cohort of patients with predominantly severe AS.
Methods & Results: We analyzed data from 849 patients (71  11 years) in the Asian Valve Registry with aortic valve area (AVA) and mean gradient (MG) of 0.8  0.3 cm2 and 45  21 mmHg, respectively. PR-adjusted AVAs were calculated with validated equations. Before PR adjustment, 621 patients showed AVA of 1.0 cm2 and, after PR adjustment, 168 (27.1 %) were reclassified to moderate AS with AVA of 1.1  0.1 cm2. These patients with reclassification after PR adjustment were characterized by lower left ventricular mass index (113.7  27.8 vs. 128.6  36.6 g/m2, p <0.001), lower MG (36  13 vs. 56  21 mmHg, p <0.001), and lower New York heart association functional class (1.57  0.65 vs. 1.80  0.77, p=0.001). Larger stroke volume (odds ratio [OR] 1.185, 95% confidence interval [CI] 1.144 – 1.226, p <0.001), lower MG (OR 0.808, 95% CI 0.773 – 0.844, p<0.001), and a smaller aortic dimension (OR 0.157, 95% CI 0.073 – 0.336, p <0.001) were independent factors associated with reclassification to moderate AS after PR adjustment. PR adjustment also decreased the frequency of low-gradient severe AS (AVA of 1.0 cm2 and MG of <40 mmHg) from 24.3 % (207/849) to 11.1% (94/849).
Conclusions: Clinically relevant PR occurs in a significant proportion of the patients with moderate to severe AS and PR adjustment can contribute to accurate classification of severe AS and prevention of discordant AS grading. Further investigations using outcome data are necessary to evaluate clinical impact of PR adjustment in this group.

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