(179) The Correlation Between Ultrasonic B Lines and Left Ventricular End-Diastolic Pressure in Severe AS

Introduction: Severe aortic stenosis (AS) requiring transcatheter aortic valve implantation is a common cardiac disease in Europe and North America. The development of heart failure is a turning point in the natural course of AS. Pulmonary edema and elevated left ventricular pressure (LVP) are cardinal features of heart failure. EEvaluatingpulmonary edema by lung ultrasound is taking the upper hand as a bedside, noninvasive tool and possibly reflects LVP.

Aim: This study assesses the correlation of sonographic pulmonary congestion, Invasive LV pre-A pressure, and Echocardiographic estimation of LVEDP in patients with symptomatic AS who will undergo transcatheter aortic valve replacement.

Methods: Patients with severe AS were enrolled and planned for Transcatheter aortic valve implantation (TAVI). All patients had a complete echocardiography evaluation and lung ultrasound (LUS) with the 12 scanning-site assessment. Invasive LV pre-A pressure was used as a reference, with >12 mm Hg defined as elevated.

Results: Forty-eight patients (25 women (52%), mean age 75 years, (SD)± 7.7 years were enrolled in the study.
Table 1 shows the baseline characteristics of the study population and the comparisons between the different degrees of severity of ultrasound B lines.
We found a severe degree of B-lines (≥30) in( 13) 27% and moderate (15-30) in (33 )68.6 % of all patients. Furthermore, the number of B-lines increased significantly along with the worsening NYHA functional classes (Figure 1), from 13 ± 12 in NYHA Class I, through 19 ± 15 in Class II, to 43 ± 34 in Class III (p < 0.05, rho = 0.383).
The number of B-lines was correlated (Figures 2 ) with LVEF (R = −0.325, p < 0.05), and E/E’ (R = 0.664, p < 0.0001), LVEDP (R=0.448,p < 0.001) and Pro BNP ( R=0. 882,p < 0.008). We did not find a significant correlation between E/A, DT, and LAVI.
The LVEDP correlated well with E/E’ ( R=0.491, p< 0.001 ).
All patients showed elevated LVEDP > 12, with a mean pressure of 26 mmHg, a minimum of 13 mmHg, and a maximum of 45 mmHg, SD± 7.8.

Conclusions: Evaluating B-lines is a simple, highly feasible method to detect pulmonary congestion in AS. The number of B-lines correlates with invasive LVEDP measurement, LVEF, E/E’, and the functional status of patients. All patients had elevated LVDEP that correlates only with E/E’.