Abstract 17451: Use of Intracardiac Echocardiography to Predict Follow-Up Hemodynamic Changes After Transcatheter Pulmonary Valve Implantation

Abstract

Objective: Evaluate the correlation between intracardiac echocardiography (ICE) gradients and next-day and one-month transthoracic echocardiography (TTE) gradients, after percutaneous pulmonary valve implantation (PPVI) Background: Post-procedure Doppler-derived gradients have gained popularity as acceptable parameters to evaluate valve function after PPVI, but they have no proven correlation with the invasive gradient measured during the procedure, indeed a large disparity between these two measurements has been described. Interestingly, ICE gradients, which are also an invasive assessment, have been suggested to present a strong correlation with post-procedure echocardiographic evaluations, and their application could allow a more accurate and predictable evaluation of valve function, establishing a typical pattern of short-term hemodynamic progression in these patients. Methods: We performed a retrospective chart review of 84 patients who underwent PPVI between January 2018 and December 2019 and selected 51 patients in whom ICE was performed after valve implantation. We evaluated the correlation between ICE and RV-PA gradients with post-procedural Doppler-derived gradients. Among the parameters assessed, the one which demonstrated the strongest correlation was used to create a predictive model to estimate the expected gradients after PPVI. Results: All the assessed correlation models between Doppler-derived parameters during ICE evaluation and post-procedure TTE evaluations were statistically significant, and presented moderate to strong linear relationships. The strongest correlation was found between ICE Doppler mean gradient and post-procedural Doppler mean gradient. The derived predictive equation was distributed by the size of the device implanted and body mass index. We found this model was capable of predicting post-procedural evaluations (mean Doppler-derived gradients at 1 day and 1 month) within a range of ±5 mmHg from the observed value in more than 80% of cases. Conclusions: There is a strong correlation between ICE and post-procedure TTE. This allowed us to derive a predictive equation, distributed by body size and device size that defines expected echo Doppler-derived hemodynamic pathways after PPVI.