Invasive Assessment of Doubtful Aortic Stenosis by Measuring Simultaneous Transaortic Gradient With a Pressure Wire

• Published in: The American journal of cardiology Vol. 111; no. 12; pp. 1772 - 1777
• Main Authors: Chopard, Romain, MD, Meneveau, Nicolas, MD, PhD, Plastaras, Philoktimon, MD, Janin, Sebastien, MD, Seronde, Marie-France, MD, Ecarnot, Fiona, MSc, Schiele, Francois, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.06.2013; Elsevier Limited
• Subjects: Adult; Aged; Agreements; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Cardiac Catheterization - methods; Cardiology; Cardiovascular; Cardiovascular disease; Catheters; Cohort Studies; Confidence intervals; Echocardiography - methods; Female; Follow-Up Studies; Heart; Humans; Intubation; Male; Methods; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Stents; Stroke; Stroke Volume; Transducers, Pressure
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.02.033

Two-dimensional transthoracic echocardiography (2D-TTE) is the reference technique for evaluating aortic stenosis (AS) but may be unreliable in some cases. We aimed to assess whether the use of a pressure wire to measure simultaneous transaortic gradient and aortic valve area (AVA) could be helpful in patients in whom initial noninvasive evaluations were considered doubtful for AS. Fifty-seven patients (mean age 76 years; 39 men) underwent cardiac catheterization with single arterial access for assessment of AVA with the Gorlin and Gorlin formula. Transaortic pressure was obtained by 2 invasive methods: (1) conventional pullback method (PM) from the left ventricle toward the aorta and (2) simultaneous method (SM) with transaortic pressure simultaneously recorded with a 0.014-inch pressure wire introduced into the left ventricle and with a diagnostic catheter placed in the ascending aorta. Reasons for inaccurate assessment by 2D-TTE were low flow states (88%) and/or atrial fibrillation (79%). Agreement for severe AS defined by AVA <0.6 cm²/m² between SM and 2D-TTE and between SM and PM was fair, with kappa coefficients of 0.38 (95% confidence interval [CI] 0.14–0.75) and 0.36 (95% CI 0.22–0.7) respectively; agreement was poor between 2D-TTE and PM (kappa: 0.23; 95% CI 0.002–0.36). SM led to a reclassification of the severity of AS in 9 patients (15.8%) compared with 2D-TTE and in 11 patients (19.3%) compared with PM. In conclusion, invasive evaluation of doubtful AS by measuring simultaneous transaortic gradient using a pressure wire may provide an attractive method that can lead to a change in therapeutic strategy in a substantial proportion of patients.