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Background <p>There are limited data on the diagnostic role of invasively measured transvalvular flow rate (TFR) in patients with low-gradient (mean gradient &lt; 40 mmHg) severe aortic valve stenosis (AS) (aortic valve area (AVA) ≤ 1 cm<sup>2</sup>) before transcatheter aortic valve implantation (TAVI).</p> Objectives <p>To evaluate the role of invasively measured TFR as a diagnostic tool for likely severe discordant AS in patients with preserved left ventricular ejection fraction (LVEF).</p> Methods <p>We included 134 patients from a single-center registry, who had low-gradient, severe AS, and normal LVEF, and underwent pre-TAVI invasive hemodynamic evaluation. Patients were divided into likely and unlikely severe AS according to the latest European Society of Cardiology (ESC) guidelines.</p> Results <p>Patients with likely and unlikely severe AS had comparable stroke volume index (SVi) (32.01 ± 9.15 vs. 34.09 ± 11.36 ml/m<sup>2</sup>, <i>p</i> = 0.536), while the likely severe AS group had a lower TFR (159 ± 51.03 vs. 180 ± 56.03 ml/s, <i>p</i> = 0.044). We found that 77.3% of patients with a SVi &gt; 35 ml/m<sup>2</sup> had TFR ≤ 200 ml/s. Patients with likely severe AS showed lower 5-year cardiac mortality compared with unlikely severe AS after TAVI (adj. HR 0.40; 95% CI 0.17–0.95, <i>p</i> = 0.038), and comparable to high-gradient severe AS (21.3% vs. 26.2%, log rank, <i>p</i> = 0.847). TFR ≤ 200 ml/s was highly associated with the diagnosis of likely severe AS (adj. OR 3.09; 95% CI 1.30–7.34, <i>p</i> = 0.010). Integrating TFR into the diagnostic criteria for severe AS could predict 5-year cardiac mortality (adj. HR 0.45; 95% CI 0.21–0.97, <i>p</i> = 0.042), unlike SVi.</p> Conclusion <p>Low invasive TFR is highly associated with the diagnosis of likely severe AS. Likely severe discordant AS with normal LV systolic function showed better long-term outcome after TAVI.</p> Graphical Abstract <p></p>

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Invasive transvalvular flow rate to predict likely severe aortic valve stenosis with low-gradient and normal ejection fraction

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Karim Elbasha,
  • Arief Kurniadi,
  • Mohamed Samy,
  • Martin Landt,
  • Sultan Alotaibi,
  • Marwa Zakaria,
  • Ralph Toelg,
  • Holger Nef,
  • Gert Richardt,
  • Nader Mankerious,
  • Abdelhakim Allali

摘要

Background

There are limited data on the diagnostic role of invasively measured transvalvular flow rate (TFR) in patients with low-gradient (mean gradient < 40 mmHg) severe aortic valve stenosis (AS) (aortic valve area (AVA) ≤ 1 cm2) before transcatheter aortic valve implantation (TAVI).

Objectives

To evaluate the role of invasively measured TFR as a diagnostic tool for likely severe discordant AS in patients with preserved left ventricular ejection fraction (LVEF).

Methods

We included 134 patients from a single-center registry, who had low-gradient, severe AS, and normal LVEF, and underwent pre-TAVI invasive hemodynamic evaluation. Patients were divided into likely and unlikely severe AS according to the latest European Society of Cardiology (ESC) guidelines.

Results

Patients with likely and unlikely severe AS had comparable stroke volume index (SVi) (32.01 ± 9.15 vs. 34.09 ± 11.36 ml/m2, p = 0.536), while the likely severe AS group had a lower TFR (159 ± 51.03 vs. 180 ± 56.03 ml/s, p = 0.044). We found that 77.3% of patients with a SVi > 35 ml/m2 had TFR ≤ 200 ml/s. Patients with likely severe AS showed lower 5-year cardiac mortality compared with unlikely severe AS after TAVI (adj. HR 0.40; 95% CI 0.17–0.95, p = 0.038), and comparable to high-gradient severe AS (21.3% vs. 26.2%, log rank, p = 0.847). TFR ≤ 200 ml/s was highly associated with the diagnosis of likely severe AS (adj. OR 3.09; 95% CI 1.30–7.34, p = 0.010). Integrating TFR into the diagnostic criteria for severe AS could predict 5-year cardiac mortality (adj. HR 0.45; 95% CI 0.21–0.97, p = 0.042), unlike SVi.

Conclusion

Low invasive TFR is highly associated with the diagnosis of likely severe AS. Likely severe discordant AS with normal LV systolic function showed better long-term outcome after TAVI.

Graphical Abstract