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Long intervals between LV, aortic systolic pressure peaks may indicate valve calcification
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Patients with severe aortic valve calcification had a higher time interval measured between peak left ventricular and peak aortic systolic pressure peaks, according to a study published in JAMA Cardiology.
“Our results suggest that a time between LV and aortic systolic pressure peaks is a more sensitive parameter to evaluate anatomic deformation of [the aortic valve] than conventional echocardiographic parameters, especially in patients with [low-gradient aortic stenosis],” Kimi Sato, MD, PhD, of the Heart and Vascular Institute at the Cleveland Clinic Foundation, and colleagues wrote.
TAVR in severe aortic stenosis
Researchers analyzed data from 123 patients (mean age, 81 years; 54% men) with severe aortic stenosis who were scheduled to undergo transcatheter aortic valve replacement via femoral access between Oct. 5, 2015, and July 20, 2016.
Patients underwent cardiac CT before TAVR to assess aortic stenosis severity and echocardiography to collect information on variables such as peak aortic valve velocity, LV outflow tract diameter and LV end-diastolic volume. Hemodynamic measurements were recorded during the procedure to obtain LV and aortic pressure and time.
Of the patients in the study, 39% had low-gradient aortic stenosis, defined as less than 40 mm Hg. The mean time interval measured between peak LV and peak aortic systolic pressure was 69 milliseconds.
After adjusting for all relevant conventional echocardiographic indicators of aortic stenosis severity, a higher peak aortic valve velocity (OR = 1.01; 95% CI, 1-1.02) and a higher time interval measured between peak LV and peak aortic systolic pressure (OR = 1.02; 95% CI, 1.01-1.04) were independently associated with severe aortic valve calcification.
The addition of time interval measured between peak LV and peak aortic systolic pressure to aortic valve area and peak aortic valve velocity showed incremental value in determining its link with aortic valve calcification, with an integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16) and a net reclassification improvement of 0.61 (95% CI, 0.23-0.99).
The only parameter associated with severe aortic valve calcification in patients with low-grade aortic stenosis was a longer time interval measured between peak LV and peak aortic systolic pressure (OR = 1.02; 95% CI, 1.001-1.04).
“Prospective studies, including larger populations of patients with varying severity of [aortic stenosis], are needed to confirm our findings and investigate the potential role of [time interval measured between peak LV and peak aortic systolic pressure] as a marker of diagnosis and clinical outcome,” Sato and colleagues wrote.
Variation in time intervals
“While the results of the study by Sato et al are helpful and raise interesting questions, the index [time interval measured between peak LV and peak aortic systolic pressure] is unlikely to serve as a stand-alone reliable measure of [aortic stenosis] severity, as it is subject to wide variation because of abnormal baseline arterial elastance and compliance properties in patients with [aortic stenosis],” Mackram F. Eleid, MD, associate professor of medicine at Mayo Clinic in Rochester, Minnesota, and Rick A. Nishimura, MD, chair in the division of structural heart disease at Mayo Clinic, wrote in a related editorial. “Furthermore, it must be emphasized that these ‘new’ parameters usually reflect the pathophysiologic findings shown to be clinically useful decades ago.” – by Darlene Dobkowski
Disclosures: Sato, Eleid and Nishimura report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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