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Diagnostic Value of Invasive Trans-Valvular Flow Rate to Assess Severity of Aortic Valve Stenosis with Low-Gradient and Normal Ejection Fraction

https://doi.org/10.1007/s00392-025-02625-4

Karim Elbasha (Bad Segeberg)1, A. Kurniadi (Bad Segeberg)1, M. Samy (Bad Segeberg)2, M. Landt (Bad Segeberg)1, S. K. M.. Alotaibi (Jeddah)3, R. Tölg (Bad Oldesloe)4, V. Geist (Bad Segeberg)1, H. Nef (Bad Segeberg)2, G. Richardt (Bad Oldesloe)5, N. Mankerious (Bad Segeberg)2, A. Allali (Lübeck)6

1Segeberger Kliniken GmbH Herzzentrum Bad Segeberg, Deutschland; 2Segeberger Kliniken GmbH Herz- und Gefäßzentrum Bad Segeberg, Deutschland; 3King Fahad Armed Forces Hospital Jeddah, Saudi Arabien; 4Asklepios Klinik Bad Oldesloe Zentrum für Herz-, Gefäß- und Diabetesmedizin Bad Oldesloe, Deutschland; 5Asklepios Klinik Bad Oldesloe Kardiologie Bad Oldesloe, Deutschland; 6Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland

 

Background: The diagnostic value of invasively measured transvalvular flow rate (TFR= stroke volume/ejection time) in patients with low gradient (mean gradient < 40 mmHg) severe aortic valve stenosis (AS) (AVA ≤ 1cm2) before transcatheter aortic valve implantation (TAVI) is not well studied.  

Objectives: To investigate the invasively measured TFR as a diagnostic parameter for severe discordant AS with normal left ventricular ejection fraction (LVEF)

Methods: We retrospectively included 134 patients who already had TAVI from a single center registry. All patients had a low gradient (mean gradient < 40 mmHg), severe AS (AVA ≤ 1cm2) with normal LVEF. We divided patients into those with likely and unlikely severe AS. Likely severe AS was defined according to the latest ESC guidelines.

Results: Patients with likely severe AS have smaller AVA than unlikely severe AS in trans-oesophageal echocardiography by planimetry (0.63 ± 0.26 vs. 0.71 ± 0.31 cm2, 0.034). Stroke volume index (SVi) in both likely and unlikely severe AS was (32.01± 9.15 vs. 34.09 ± 11.36, p=0.536), while the likely severe AS group had a lower TFR (159 ± 51.03 vs 180 ± 56.03 ml/sec, p=0.044). We found that 44% of patients with low SVi had TFR >200ml/sec, and 77.3% of SVi > 35ml/m2 had TFR ≤ 200 ml/sec. Patients with likely severe AS showed lower 5-years cardiac mortality after TAVI (aHR 0.36, 95% CI (0.15-0.84), p=0.018). We found that TFR≤ 200 ml/sec was highly associated with the diagnosis of likely severe AS (aOR 3.09; 95% CI 1.30-7.34, p=0.010)

Conclusion: Likely severe discordant AS with normal LV systolic function showed a better mid-term outcome after TAVI. Low TFR is highly associated with the diagnosis of likely severe AS.

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