Higher values of an echocardiography-derived pressure-adjusted heart rate metric were associated with poorer survival among patients with severe aortic stenosis, researchers reported at the American Society of Echocardiography (ASE) 2026 Scientific Sessions.
Pressure-adjusted heart rate (PAHR), defined as heart rate × (right atrial pressure / mean arterial pressure), integrates chronotropic response, venous congestion, and systemic pressure into a single index that researchers evaluated for its potential role in risk stratification.
The cohort study was presented as a late-breaking abstract by Chieh-Mei (Jessica) Tsai, MD, a research fellow in the Department of Cardiovascular Medicine at Mayo Clinic, Rochester, Minnesota.
"PAHR…consistently [identified] higher-risk patients under medical management and following AVR [aortic valve replacement]," the researchers wrote in the abstract. "PAHR may inform closer surveillance and earlier evaluation for intervention."
Study Design and Population
This retrospective study included 14,409 adult patients with severe native aortic stenosis [AS] identified on transthoracic echocardiography between 2010 and 2020. Severe AS was defined by an aortic valve area of 1 cm² or less or an indexed aortic valve area of 0.6 cm²/m² or less.
PAHR was calculated at the time of the index echocardiogram and patients were stratified into quartiles according to PAHR values. The association between PAHR and all-cause mortality was assessed using Kaplan-Meier analyses and multivariable Cox proportional hazards models adjusted for age, sex, Charlson Comorbidity Index, left ventricular ejection fraction, aortic valve area, and stroke volume index.
Researchers evaluated survival under medical management by censoring follow-up at the time of AVR and assessed mortality following AVR from the time of intervention.
PAHR and Survival
During untreated follow-up, 4,503 deaths were documented. Higher PAHR quartiles were found to be statistically significantly associated with progressively worse survival under medical management. Compared with patients in the lowest PAHR quartile, those in the second, third, and fourth quartiles had 15%, 61%, and 151% higher adjusted risks of mortality, respectively.
A total of 7,062 patients underwent AVR. During postprocedural follow-up, 2,449 deaths were reported. Baseline PAHR appeared to remain statistically significantly associated with mortality following AVR. Compared with patients in the lowest PAHR quartile, those in the third and fourth quartiles had 34% and 89% higher adjusted risks of mortality, respectively.
“We believe PAHR may provide a simple, noninvasive estimate of overall hemodynamic burden in severe AS using information already collected during routine echocardiography and vital sign assessment,” Dr. Tsai concluded in an exclusive interview with Conexiant. “Our findings suggest that conventional measures of valve severity may not fully reflect the overall hemodynamic burden experienced by patients with severe AS, and PAHR may provide complementary physiologic insight into patient risk before and after valve replacement.”
She continued, "However, PAHR should be viewed as complementary to existing approaches rather than a replacement. Before it could be incorporated into routine clinical decision-making, external validation and prospective studies are needed to determine whether serial PAHR assessment provides incremental value beyond established risk markers and whether it can improve patient monitoring and timing of intervention."
No disclosure information was provided.
Source: ASE 2026 Late-Breaking Abstracts