Pfenniger Anna, Stolte Thorald, Reichl Jakob Johannes, Leibundgut Gregor, Wagener Max, Kaiser Christoph, Boeddinghaus Jasper, Mahfoud Felix, Nestelberger Thomas
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland.
Cardiovasc Interv Ther. 2025 Apr;40(2):362-377. doi: 10.1007/s12928-024-01074-6. Epub 2024 Dec 19.
Transcatheter aortic valve implantation (TAVI) is recommended for treatment of high-risk aortic stenosis patients. While measuring mean transaortic valve gradient (MG) is crucial in evaluating procedural success, echocardiographic measurements often overestimate direct invasive measurements. This study aimed to examine the discordance between echocardiographic and invasive MGs in TAVI patients and assess their prognostic value on long-term outcomes. This prospective registry included consecutive TAVI patients at a tertiary university hospital. Transthoracic or transoesophageal echocardiography was performed pre-TAVI, at discharge, 1 month, 1, and 5 years with invasive MG measurements obtained peri-procedurally. The primary endpoints were 5-year all-cause mortality and major adverse cardiac events. Among 1353 patients from 2011 to 2023, non-invasive MGs exceeded invasive MGs pre- and post-implantation (43 [36, 52] mmHg vs. 40 [30, 50] mmHg, p < 0.001; 9 [6, 12] mmHg vs. 4 [2, 7] mmHg, p < 0.001) Pre-procedural MGs correlated better than post-procedural MGs (r = 0.70, p < 0.001 vs. r = 0.23, p < 0.001), particularly in self-expandable valves and smaller sinus of Valsalva diameter (SOVd) (r = 0.33, p < 0.001; r = 0.46, p < 0.001 vs R = 0.06, p = 0.701). Non-invasive MG remained stable from discharge (9 [6, 12] mmHg) to 5 years (9 [7, 12] mmHg). While structural valve deterioration and patient-prosthesis mismatch showed no impact, extreme invasive MGs (< 3 or > 6 mmHg) predicted worse outcomes (mortality hazard: 1.25 [1.06, 1.88] and 0.85 [0.8, 0.95], respectively), unlike non-invasive measurements. In conclusion, invasive as compared with non-invasive MGs correlated better before than after valve implantation, whereas invasive MGs were always lower than non-invasive MGs. Lower invasive MGs after TAVI appeared to be associated with favourable long-term outcomes.
经导管主动脉瓣植入术（TAVI）被推荐用于治疗高危主动脉瓣狭窄患者。虽然测量平均跨主动脉瓣压差（MG）对于评估手术成功率至关重要，但超声心动图测量往往高估了直接侵入性测量结果。本研究旨在探讨TAVI患者中超声心动图测量的MG与侵入性测量的MG之间的不一致性，并评估它们对长期预后的预测价值。这项前瞻性登记研究纳入了一家三级大学医院连续的TAVI患者。在TAVI术前、出院时、1个月、1年和5年时进行经胸或经食管超声心动图检查，并在围手术期获得侵入性MG测量值。主要终点是5年全因死亡率和主要不良心脏事件。在2011年至2023年的1353例患者中，植入前和植入后非侵入性MG均超过侵入性MG（43[36,52]mmHg对40[30,50]mmHg，p<0.001；9[6,12]mmHg对4[2,7]mmHg，p<0.001）。术前MG的相关性优于术后MG（r=0.70，p<0.001对r=0.23，p<0.001），特别是在自膨胀瓣膜和较小的主动脉瓣环直径（SOVd）中（r=0.33，p<0.001；r=0.46，p<0.001对R=0.06，p=0.701）。从出院时（9[6,12]mmHg）到5年（9[7,12]mmHg），非侵入性MG保持稳定。虽然结构性瓣膜退化和患者-人工瓣膜不匹配未显示出影响，但极端的侵入性MG（<3或>6mmHg）预测预后较差（死亡风险分别为：1.25[1.06,1.88]和0.85[0.8,0.95]），与非侵入性测量结果不同。总之，与非侵入性MG相比，侵入性MG在瓣膜植入前的相关性更好，而侵入性MG始终低于非侵入性MG。TAVI术后较低的侵入性MG似乎与良好的长期预后相关。
