Are we underestimating the gradient in patients with aortic stenosis and atrial fibrillation: it’s time to consider ventricular preload

Abstract

Purpose: To understand the significance of variation in gradient beat-to-beat pressure gradients in patients with significant aortic stenosis and concomitant atrial fibrillation and determine its relationship to severity.
Methods: Assess the beat-to-beat variability of pressure gradients in patients significant aortic stenosis and concomitant atrial fibrillation from retrospective analysis of Doppler or catheter-based hemodynamic measurements and correlate with the preceding RR interval based on the corresponding electrocardiogram. Results: There is a direct correlation between the preceding RR interval and the mean pressure gradient in patients with significant aortic stenosis and concomitant atrial fibrillation. The variation seems to be more prominent in those with severe stenosis and preserved left ventricular function and may aid in classifying the degree of stenosis as severe in some with seemingly more moderate stenosis based on traditional averaging of consecutive beats.
Conclusions: Variation in pressure gradients beat-to-beat are important to consider in patients with aortic stenosis and concomitant atrial fibrillation and correlate with severity and contractile characteristics.