P1636Utility and safety of pressure wires use in hemodynamic assessment of paradoxical low flow low gradient aortic stenosis

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Background: Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable differences between echo and catheterization (cath) lab measurements. Low flow/ low gradient (LF/LG) severe aortic stenosis (AS) with preserved EF constitutes a real challenge with no clear method to confirm the severity of AS in this group. Normal flow/ low gradient AS with preserved EF is considered as echocardiography miscalculation by guidelines. Purpose: To evaluate whether using pressure wire for aortic stenosis assessment may offer a safe and higher quality technique to assess the severity of AS in LF/LG and NF/LG AS with preserved EF. Methods: 297 Sequential patients with AVA <1cm 2 on echocardiography underwent right and left heart cath by two operators with pressure gradients via left ventricular (St. Jude) pressure wire and ascending aorta catheter. Of these, there were 95 with high gradient (HG), 117 with LF/LG and 67 with NF/LG. Cath derived values were based on simultaneous pressure wire recording of left ventricular pressure and fluid filled pressure catheter recording of aortic pressure measured >5 cm above the valve. Cardiac output was calculated by thermodilution.

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