Abstract 17917: Effect of Transcatheter Aortic Valve Replacement (TAVR) on the Dicrotic Notch in Patients With Severe Aortic Stenosis

Abstract

Background: The dicrotic notch in the aortic pressure waveform is seen around the time of closure of the aortic valve at the end of systole and the beginning of diastole. We aim to study the change in the dicrotic notch post TAVR in patients with severe AS and its impact on clinical outcomes. Methods: We included patients with severe AS who underwent TAVR consecutively between 2019-2020. Central aortic pressure waveforms were reviewed from the SyngoDynamics imaging software (Siemens Healthcare, Malvern, PA) for the invasive hemodynamic data obtained during TAVR. Heights of the systolic, diastolic blood pressure and dicrotic notch waveforms are measured. Dicrotic notch index (DNI) is calculated as the difference between the SBP and dicrotic notch divided by the pulse pressure (see figure 1). The invasive hemodynamics are compared between pre and post TAVR using independent samples t test. Statistical significance was defined as two-tailed p-value less than 0.05. Survival analysis is performed using cox regression. Results: A total of 724 patients (1448 studies) were evaluated. There is significant increase in dicrotic notch pressure (p<0.001) and DNI (p<0.001) post-TAVR in the overall population. Women (n=310) had a higher pre-TAVR and post-TAVR DNI (p<0.001 and p<0.01 respectively). Figure 1 shows hemodynamic characteristics of before and after TAVR. Heart failure hospitalization (HFH) or mortality at 3 years (composite outcome) was present in 146 patients (20.1%). DNI was lower in patients reaching composite outcomes compared to patients surviving without HFH (p<0.001). Conclusion: Higher DNI after TAVR is associated with lower HFH and mortality after TAVR. Simple measurement of DNI offer substantial prognostic value to patients with severe AS undergoing TAVR.