title: Invasive assessment of doubtful aortic stenosis by measuring simultaneous transaortic gradient with a pressure wire.
abstract: 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.
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, University of Franche-Comte, EA 3920, Besançon, France. rchopard@chu-besancon.fr
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.forename: Philoktimon
authors.initials: P
authors.lastname: Plastaras
authors.forename: Sebastien
authors.initials: S
authors.lastname: Janin
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Seronde
authors.forename: Fiona
authors.initials: F
authors.lastname: Ecarnot
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D013318:Stroke Volume; D014160:Transducers, Pressure