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

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• 作者：Romain Chopard ; MD ; ^{rchopard@chu-besancon.fr} ; Nicolas Meneveau ; MD ; PhD ; Philoktimon Plastaras ; MD ; Sebastien Janin ; MD ; Marie-France Seronde ; MD ; Fiona Ecarnot ; MSc ; Francois Schiele ; MD ; PhD
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 June, 2013
• 年：2013
• 卷：111
• 期：12
• 页码：1772-1777
• 全文大小：923 K

文摘

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.