Clinical InvestigationsAortic Stenosis Assessment in Atrial FibrillationDoppler Mean Gradient Is Discordant to Aortic Valve Calcium Scores in Patients with Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement
Section snippets
Study Population
Patients undergoing TAVR between January 1, 2016, and April 1, 2020, for native valve severe AS with LVEF ≥ 50% were identified from the Mayo Clinic TAVR and echocardiography laboratory databases. The study period was commensurate with the updated 2014 valve disease management guidelines6 and updated AS echocardiographic assessment guidelines12 and the evolving criteria for TAVR in clinical practice, including multidisciplinary heart team evaluation. Patients were divided according to rhythm
Results
A total of 633 patients were included; the median age was 82 years (IQR, 76–86 years), and 46% were women. The rhythm during the echocardiogram was SR in 524 (83%) and AF in 109 (17%) patients.
Discussion
In the present study we examined AVCS and their relationship to Doppler MGs obtained during AF versus SR in patients who were diagnosed with native valve severe AS and subsequently underwent TAVR. The major findings were that (1) AVCS were discordant to MGs obtained during AF compared with SR, especially in men, and (2) men with HGAS during AF had very high AVCS compared with their counterparts.
The diagnosis of severe AS is not in doubt in the setting a Doppler MG ≥ 40 mm Hg or peak aortic jet
Conclusion
Echocardiographic Doppler MG obtained during AF versus SR was discordant to computed tomography–determined AVCS in patients undergoing TAVR for native valve severe AS. This discordance was most pronounced in men with AF, who had very high AVCS consistent with more advanced AS compared with their counterparts. The mechanisms of the more advanced AS at the time of TAVR may be related to underestimated AS severity during progressive AS because of lower flow and/or late referral to TAVR. In the
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The Department of Cardiovascular Medicine at the Mayo Clinic provided funding for data retrieval.
Conflicts of interests: None.