ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2025
Prognostic value of invasive versus echocardiography-derived aortic gradient in patients undergoing TAVI.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Understanding prosthesis patient mismatch in aortic valve replacement: from pitfalls to clinical impact.Cardiovascular intervention and therapeutics · 2026Review
- Long-term outcomes after balloon- or self-expandable transcatheter aortic valve replacement in small aortic annuli.Cardiovascular intervention and therapeutics · 2026Article
- Invasive and echocardiographic gradients of self- and balloon-expandable valves in failing aortic bioprostheses.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
- Midterm Clinical and Echocardiographic Outcomes After Transcatheter Aortic Valve Replacement in Patients With Severe Bicuspid Aortic Valve Stenosis.Journal of the American Heart Association · 2026Article
- Insights from the assessment of anatomical valve orifice area after transcatheter aortic valve implantation using transesophageal echocardiography.Cardiovascular intervention and therapeutics · 2026Article
- Discrepancy Between Invasive and Echocardiographic Transvalvular Gradients After TAVI Procedure: A Review of the Literature.Journal of clinical medicine · 2026Review
- Impact of Anticoagulation on Valve Hemodynamics Following Transcatheter Valve-In-Valve Implantation.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Article
- Letter: When gradients diverge: integrating invasive assessment into post-TAVI surveillance.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- The challenge of interpreting comparative TAVI studies.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- From invasive gradients to pressure recovery: rethinking long-standing paradigms.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- Patient-specific Factors Influencing Choice of Transcatheter Aortic Valve Prosthesis.Interventional cardiology (London, England) · 2025Review
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11 authors.
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Abstract
backgroundRecent studies report a discordance between invasive and echocardiography-derived gradients after transcatheter aortic valve implantation (TAVI) with balloon-expandable (BEV) and self-expanding valves (SEV). There are limited data on the determinants and clinical implications of this discordance.
aimsWe aimed to examine the prognostic value of invasive and echocardiography-derived gradients after implantation of SEV and BEV and to compare gradients for SEV versus BEV.
methodsWe performed a retrospective, propensity score-matched study. Invasive measurements were obtained before and immediately after TAVI. Echocardiography was performed before and within 24 hours after TAVI, and at 1 year. Clinical outcomes were assessed at 30 days, 1 year, and 2 years.
resultsThe 1:1 propensity score matching resulted in 436 matched pairs (436 SAPIEN 3 and 436 Evolut). Invasive gradients post-TAVI independently predicted higher risk for all-cause mortality at 30 days, 1 year and 2 years as a continuous variable (hazard ratio [HR] 1.07, 95% confidence interval [CI]: 1.00-1.14; p=0.038; HR 1.06, 95% CI: 1.01-1.11; p=0.007; HR 1.05, 95% CI: 1.01-1.09; p=0.011, respectively) and by using >10 mmHg as a cutoff (HR 1.95, 95% CI: 1.13-4.78; p=0.028; HR 1.91, 95% CI: 1.11-3.65; p=0.030; HR 1.61, 95% CI: 1.03-2.96; p=0.021, respectively), but echocardiography-derived gradients did not (HR 1.13, 95% CI: 0.87-1.75; p=0.247; HR 1.02, 95% CI: 0.95-1.10; p=0.639; HR 0.99, 95% CI: 0.94-1.07; p=0.979, respectively). Mean gradients before and after TAVI were higher by echocardiography than by invasive measurements. The difference was more pronounced after implantation with BEV than SEV (7.0 [25th-75th percentile: 4.0-11.0] mmHg vs 5.0 [2.0-7.0] mmHg; p<0.001). Smaller valve size, higher ejection fraction and higher stroke volume amplified the discordance. Invasive mean gradients were similar after SEV and BEV (3.0 [0.0-6.0] mmHg vs 3.0 [0.0-6.0] mmHg; p=0.166), but echo-derived mean gradients were lower after SEV versus BEV (8.0 [6.0-11.0] mmHg vs 11.0 [8.0-14.0] mmHg; p<0.001).
conclusionsOnly invasively measured but not echocardiography-derived transvalvular mean gradients correlate with 30-day, 1-year and 2-year mortality. Aortic gradient measurements are higher by echocardiography than by invasive assessment and more so for BEV than SEV. Smaller valve size, higher ejection fraction and higher stroke volume increase this discordance between echocardiography and invasive assessment.
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