Valvular & structural heart disease
Prognostic value of invasive versus echocardiography-derived aortic gradient in patients undergoing transcatheter aortic valve implantation (TAVI)
Authors' conclusion
Only invasively measured but not echocardiography-derived transvalvular mean gradients correlate with 30-day, 1-year and 2-year mortality. Aortic gradient measurements are higher by echocardiography than by invasive assessment and more so for BEV than SEV. Smaller valve size, higher ejection fraction and higher stroke volume increase this discordance between echocardiography and invasive assessment.
Study context
- Population
- Patients undergoing TAVI with balloon-expandable (SAPIEN 3) or self-expanding (Evolut) valves
- Participants
- 436 matched pairs
- Exposure
- Prognostic value of invasive versus echocardiography-derived gradients after TAVI; gradients for self-expanding valves (SEV) versus BEV
- SEVn = 436
- BEVn = 436
- Outcome
- All-cause mortality by invasive gradient post-TAVI (continuous variable)
- Follow-up
- 30 days, 1 year and 2 years
Methodological details1:1 propensity score matching
- 1:1 propensity score matching
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
All-cause mortality by invasive gradient >10 mmHg cutoff · 30 days, 1 year and 2 years
| HR (95% CI) | P value | ||
|---|---|---|---|
| Invasive gradient >10 mmHg30 days | 1.95 (1.13–4.78) | P = 0.028 | |
| Invasive gradient >10 mmHg1 year | 1.91 (1.11–3.65) | P = 0.030 | |
| Invasive gradient >10 mmHg2 years | 1.61 (1.03–2.96) | P = 0.021 | |
| 0.20.5125Hazard ratio (log scale) |
All-cause mortality by echocardiography-derived gradients · 30 days, 1 year and 2 years
| HR (95% CI) | P value | ||
|---|---|---|---|
| Echocardiography-derived gradient30 days | 1.13 (0.87–1.75) | P = 0.247 | |
| Echocardiography-derived gradient1 year | 1.02 (0.95–1.10) | P = 0.639 | |
| Echocardiography-derived gradient2 years | 0.99 (0.94–1.07) | P = 0.979 | |
| 0.512Hazard ratio (log scale) |
Difference between echocardiography and invasive mean gradients · after TAVI · difference more pronounced after BEV than SEV
P < 0.001
Invasive mean gradients · after TAVI · similar
P = 0.166
Echo-derived mean gradients · after TAVI · lower after SEV
P < 0.001
Difference between echocardiography and invasive mean gradients · after TAVI
- Mean gradients before and after TAVI were higher by echocardiography than by invasive measurements
- Smaller valve size, higher ejection fraction and higher stroke volume amplified the discordance
Original publication
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