Intracardiac Doppler Echocardiography for Monitoring of Pulmonary Artery Pressures in High-Risk Patients Undergoing Transcatheter Aortic Valve Replacement

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• 作者：Silvana Mü ; ller ; MD^a ; Corinna Velik-Salchner ; MD^b ; Michael Edlinger ; MSc ; PhD^c ; Nikolaos Bonaros ; MD^d ; Anneliese Heinz ; MD^d ; Gudrun Feuchtner ; MD^e ; Thomas Bartel ; MD ; PhD^f ; ^{bartelt@clevelandclinicabudhabi.ae" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Aortic stenosis ; Pulmonary hypertension ; Transcatheter aortic valve replacement ; Intracardiac echocardiography ; Hemodynamic monitoring
• 刊名：Journal of the American Society of Echocardiography
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：29
• 期：1
• 页码：83-91
• 全文大小：1795 K

文摘

Uncontrolled pulmonary hypertension may cause worse outcomes after transcatheter aortic valve replacement (TAVR), while hemodynamic monitoring is desirable for risk control. Pulmonary artery pressure (PAP) readings obtained by intracardiac Doppler echocardiography were evaluated.

Methods

In 114 patients with symptomatic aortic stenosis and median Society of Thoracic Surgeons scores of 10.5% (interquartile range, 7.7%–15.0%), transfemoral and transapical TAVR was guided by intracardiac Doppler echocardiography. The continuous-wave Doppler beam interrogated the jet of tricuspid regurgitation from the “home view” position. Systolic PAP (PAP_s) was estimated as the sum of the pressure gradient derived from the maximum transtricuspid regurgitation jet velocity and the central venous pressure. Mean PAP (PAP_m) was calculated by the mean gradient method (1) and the Chemla formula (2). Measurements were obtained immediately before and after TAVR.

Results

Pre- and postinterventional readings showed marginal pressure underestimation in comparison with measurements derived from right-heart catheterization: PAP_s, −2.7 (95% CI, −3.3 to 2.1) and −1.4 (95% CI, −1.9 to −0.9); PAP_m by the mean gradient method, −1.9 (95% CI, −2.2 to −1.6) and −0.1 (95% CI, −0.4 to 0.2). Agreement (95% limits) for PAP_s was −8.6 to 3.2 and −6.8 to 4.0; agreement for PAP_m by the mean gradient method was −5.4 to 1.6 and −3.4 to 3.2. The repeatability coefficient (95% limits of agreement) for PAP_s was excellent: 3.4 (−4.2 to 2.5) and 5.5 (−5.3 to 5.8); repeatability for PAP_m was higher by the mean gradient method than by the Chemla method. In ≥85% of patients with pulmonary hypertension, PAP_m improved after valve deployment.

Conclusions

Intracardiac Doppler echocardiography–derived monitoring of PAP by the mean gradient method is accurate and well applicable to high-risk TAVR candidates for intraprocedural risk control.