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Valvular heart disease
Original research
Effect of race on pressure recovery adjustment for prevention of aortic stenosis grading discordance
  1. Jin Kyung Oh1,
  2. Mylène Shen2,
  3. Ezequiel Guzzetti2,
  4. Lionel Tastet2,
  5. Krithika Loganath3,
  6. Simona Botezatu3,
  7. Seung-Ah Lee4,
  8. Sahmin Lee4,
  9. Dae-Hee Kim4,
  10. Jong-Min Song4,
  11. Duk-Hyun Kang4,
  12. Marc R Dweck3,
  13. Philippe Pibarot2,
  14. Marie-Annick Clavel2,
  15. Jae-Kwan Song4
  1. 1 Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
  2. 2 Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
  3. 3 British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  4. 4 Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr Jae-Kwan Song, Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; jksong{at}amc.seoul.kr

Abstract

Objective We sought to evaluate the potential impact of racial difference (Asians vs Caucasians) on the clinical usefulness of pressure recovery (PR) adjustment for preventing discordant aortic stenosis (AS) grading in patients with severe AS.

Methods Data from 1450 patients (mean age, 70.2±10.6 years; 290 (20%) Caucasians; aortic valve area (AVA), 0.77±0.26 cm2) were retrospectively analysed. PR-adjusted AVA was calculated using a validated equation. Discordant grading of severe AS was defined as AVA of <1.0 cm2 and mean gradient of <40 mm Hg. The frequency of discordant grading was assessed in the overall cohort and the propensity score-matched cohort.

Results Before PR adjustment, 1186 patients showed AVA values of <1.0 cm2; after PR adjustment, 170 (14.3%) were reclassified as having moderate AS. PR adjustment decreased the frequency of discordant grading from 31.4% to 14.1% in Caucasians and from 13.8% to 7.9% in Asians. Patients with reclassification to moderate AS after PR adjustment had a significantly lower risk of a composite of aortic valve replacement or all-cause death than did those with severe AS after PR adjustment (HR 0.38; 95% CI 0.31–0.46; p<0.001). In propensity score-matched cohorts (173 pairs), the frequency of discordant grading before PR adjustment was 42.2% and 43.9% in the Caucasian and Asian patients, respectively, which decreased to 21.4% and 20.2%, respectively, after PR adjustment.

Conclusions Clinically relevant PR occurred, regardless of race in patients with moderate to severe AS. Routine PR adjustment may be useful for reconciling discordant AS grading.

  • aortic valve stenosis
  • echocardiography

Data availability statement

Data are available upon reasonable request. The data sets used during the current study are available from the corresponding author on reasonable request. The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the BMJ Publishing Group Ltd and its licensees to permit this article (if accepted) to be published in Heart editions and any other BMJPGL products to exploit all subsidiary rights.

https://doi.org/10.1136/heartjnl-2023-322586

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    Data availability statement

    Data are available upon reasonable request. The data sets used during the current study are available from the corresponding author on reasonable request. The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the BMJ Publishing Group Ltd and its licensees to permit this article (if accepted) to be published in Heart editions and any other BMJPGL products to exploit all subsidiary rights.

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    Footnotes

    • Twitter @MarcDweck, @PPibarot, @ClavelLabo

    • Contributors MRD, PP and M-AC participated in the study design and analysis and interpretation of the final data, as well as in the drafting and approval of the final manuscript. JKO, MS, EG, LT, KL, SB, S-AL, SL, D-HKim, J-MS and D-HKang were involved in the recruitment of participants from clinics. J-KS was responsible for the design and supervision of the study and revision of the manuscript as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MRD, M-AC, J-KS and PP are on the editorial board for BMJ Heart.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.