Abstract 16036: Interest of Central Arterial Compliance in the Occurence of Discordant Grading in Aortic Stenosis
Introduction: According to the current AHA/ACC guidelines, severe aortic stenosis (AS) is defined as a peak aortic jet velocity (Vpeak) >4m/sec, a mean gradient (MG) >40 mmHg, and/or an aortic valve area (AVA) <1cm2. However, cardiologists are often confronted to discordant echocardiographic findings that are unexplained by a reduction in transvalvular flow. Discordances may raise uncertainty about the actual severity of the disease and thus therapeutic management.
Aim: The aim of this study was to identify the causes of such discordance by measuring systemic arterial compliance (SAC), which could interfere with the evaluation of AS.
Methods: Fifty-two men with mild to moderate AS underwent Doppler-echocardiography, multidetector computed tomography (MDCT), and central and peripheral blood pressure were measured in the context of the prospective PROGRESSA study. SAC was calculated as the stroke volume (SV) divided by the systemic pulse pressure (systolic blood pressure [SBP] - diastolic blood pressure [DBP]).
Results: The mean age was 63±13 years and MG 21±8 mmHg. There was a significant correlation between aortic valve calcification (AVC) and MG (r=0.62; p<0.0001). Whether using peripheral arterial compliance (PAC) or central arterial compliance (CAC), a significant interaction was found between CAV and SAC for the prediction of MG (both p<0.0001). Interestingly, CAC was a better predictor (p=0.0003) than PAC for the prediction of MG and 6 patients had reduced CAC despite normal PAC.
Conclusions: This study shows that for the same anatomic AS severity, patients with reduced SAC have a decreased MG. In these patients, AS severity could be underestimated and lead to an inappropriate treatment. In addition, patients may appear to have normal SAC when assessed in periphery despite decreased central SAC. Thus AS severity should be assessed by an alternative exam, such as MDCT, in any patient with discordant low gradient not obviously linked to measurement error.
Author Disclosures: M. Clisson: None. L. Tastet: None. R. Capoulade: None. L. Simard: None. M. Shen: None. P. Pibarot: None. M. Clavel: None.
- © 2016 by American Heart Association, Inc.