P1370 Correlation of aortic stenosis by integrated transthoracic and transesophageal echocardiography with calcium score
Abstract Funding Acknowledgements None BACKGROUND Aortic stenosis (AS) classification depends on left-ventricular ejection-fraction (LVEF <≥50%), aortic valve area (AVA<≥1cm2), mean pressure gradient (MG<≥40mmHg), peak velocity<≥400 cm/sec, and stroke-volume index (SVI<≥35ml/m2). Aortic Valve Agatston CT score (AVC) correlates with AS severity by trans-thoracic echo (TTE), but its association with AS severity determined by integrated TTE and TEE is unknown. PURPOSE We investigated correlation of AVC with dichotomous AS grouping by Integrated TTE + TEE vs TTE only. METHODS 64 TAVI candidates underwent sequential TTE and TEE, of which 24 underwent coronary CT within 4 months. Based on recommended conservative vs invasive treatment implication (A/B respectively), AS types were aggregated separately by TTE or Integrated TTE-TEE into two groups: Group-A (Moderate AS and Normal-Flow Low-Gradient), and Group-B (High-Gradient, Low-EF Low-Flow Low-Gradient, and Paradoxical Low-Flow Low-Gradient). Continuous and dichotomous AVC correlation (cutoffs based on guidelines) with echo binary classification was then determined. RESULTS Patients were 81.1(77.3-84.6) years old, 18(48.6%) were women, and had LVEF of 60% (49-65). AVC-score distribution in the two AS A/B Groups by two echo modalities is presented in the boxplot Figure. Only classification by TTE held discriminative accuracy in A/B grouping, with Area-Under-Curve of 0.736 (CI 0.57-0.9), and optimal threshold value of 1946 AU having 77% sensitivity and 74% specificity. Compared with AVC dichotomous classification, integrated TTE + TEE upgraded AS class (from A to B) in 5/6 (83.3%) patients vs 12/18 (66.7%) in which it downgraded AS class from B to A. CONCLUSIONS Aortic valve calcification correlates well with AS class dichotomized by operative implication through conventional TTE but not through integrated TTE + TEE. Our preliminary results appear to be caused by initial selection bias of patients in whom coronary CT performance was deemed to be justified by the treating physician rather than reflect a true better correlation between CT score and AS assessment by TTE vs by integrated TTE + TEE. Abstract P1370 Figure.