Echocardiographic Assessment of Severe Aortic Stenosis

TTE was performed routinely, on average 1–4 weeks before TAVR using either an iE33 or Epiq 5 (Philips Healthcare, Hamburg, Germany) ultrasound device. Examinations were conducted by experienced clinicians with more than 4 years of training in echocardiography. Severe AS was classified according to current guidelines of the European Society for Cardiology (ESC). Left ventricular ejection fraction (LVEF) was calculated using Simpson’s method. To graduate mitral, aortic and tricuspid valve regurgitation in minimal, mild (I), moderate (II) and severe (III) spectral and color-Doppler images were used. TRVmax was obtained by continuous wave Doppler over the tricuspid valve. Pulmonary artery pressure (PAP), right atrial pressure (RAP) and at least sPAP was calculated as described previously [6 (link)]. As part of an extensive literature search and a self-authored review on the topic of non-invasive ways of determining PH in severe AS, the most commonly used sPAP cut-off values of 40 and 50 mmHg were used [1 (link), 7 (link), 8 (link)]. To also assess the severity of echocardiographically determined PH, patients were further subdivided into no PH by sPAP < 35 mmHg, mild PH by sPAP 35–50 mmHg, moderate PH by sPAP 51–70 mmHg and severe PH by sPAP > 70 mmHg [9 (link)]. This classification is based on the recommendations of the American Society for Echocardiography [10 (link), 11 (link)].