TRANSSEPTAL CATHETERIZATION FOR THE EVALUATION OF AORTIC STENOSIS IN PATIENTS WITH LOW- AND PRESERVED LEFT VENTRICULAR FUNCTION

Abstract

Echocardiography is the most common diagnostic modality used in the assessment of aortic stenosis (AS). However, disparity has been noted between invasive and non-invasive evaluation of AS in patients with low-output, low-gradient states. This study attempted to identify the accuracy and agreement of echocardiography in assessment of AS compared with transseptal catheterization in patients with low and preserved left ventricular (LV) systolic function. Baseline, echocardiographic and hemodynamic characteristics from one hundred patients that underwent both echocardiography and transseptal catheterization for assessment of moderate-severe AS was collected. Data from 50 patients with low LV systolic function and 50 age-matched controls with preserved LV systolic function was analysed comparing invasive and non-invasive evaluation of AVA and AS severity classification. Echocardiography had a sensitivity, specificity and diagnostic accuracy of 98%, 100% and 98% respectively for classification of severe AS when compared with transseptal catheterization in patients with preserved LV systolic function. The sensitivity, specificity and diagnostic accuracy of echocardiography was 83%, 44% and 78% in patients with low LV systolic function. Reclassification of AS severity after invasive assessment was significantly more common in patients with low LV systolic function (22% vs. 2%, p=0.038). Bland-Altman analysis suggested better agreement between invasive and non-invasive assessment in patients with preserved rather than low LV systolic function. Amongst patients who underwent AVR, in-hospital mortality was significantly higher in the low LV systolic function cohort (15.4% vs. 2.2%, p=0.038) No major complications were noted with transseptal catheterization. Echocardiography offers an accurate assessment of AS severity in patients with preserved LV systolic function. However, discrepancies exist between echocardiography and transseptal catheterization assessment of AS severity in patients with reduced LV systolic function, suggesting invasive evaluation of AS may be necessary in this patient population.