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Characteristics and Usefulness of Unintended Premature Ventricular Contraction During Invasive Assessment of Aortic Stenosis

By: Zachary Singer, Payam Dehghani, Jamie Morrison, Jeffery Booker, Andrea Lavoie, Rodney Zimmerman, Paul Basran, John G Webb, Asim N Cheema, Phillipe Pibarot, & Marie-Annick Clavel

Background: Postextrasystolic potentiation (PESP)-associated augmentation in left ventricular-aorta pressure gradient (LVAoG) observed after incidental premature ventricular contraction (PVC) during resting echocardiography is similar to dobutamine stress echocardiography (DSE)-associated augmentation in LVAoG in patients with low-flow, low-gradient (LF-LG) aortic stenosis (AS). What is not known is whether a similar relationship exists when unintended PVC causes PESP during cardiac catheterization in patients with AS.

Methods: We retrospectively reviewed all catheterizations performed for patients with at least moderate AS who had LVAoG assessment. Univariate and multivariate analyses were conducted to determine the predictors of pre- and post-PVC mean LVAoG ≥40mmHg.

Results: Between September 2015 to September 2017, of 140 individuals undergoing cardiac catheterization, 34 met study criteria. Mean pre-PVC gradient was 38.9 ± 22.8mmHg. All patients exhibited PESP-associated augmentation of LVAoG by an average of 28 ± 12%. In multivariate analysis, the only significant predictor of post-PVC mean LVAoG ≥40mmHg was preserved LV function (OR 6.81; 95% CI 1.41-32.82, p=0.02). Inability to generate ≥40mmHg of mean LVAoG post-PVC had 100% specificity for nonsevere AS in our observational cohort.

Conclusions: Unintended but interpretable PVCs occurred in one in four patients with AS undergoing cardiac catheterization with measurable hemodynamics. All of our patients with PVCs, regardless of underlying LVEF, exhibited PESP-associated augmentation of LVAoG. Our exploratory analysis suggests that inability to generate ≥40mmHg of mean LVAoG post-PVC is highly specific for nonsevere AS.

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