A novel angiographic quantification of aortic regurgitation after TAVR provides an accurate estimation of regurgitation fraction derived from cardiac magnetic resonance imaging

M. Abdel-Wahab, M. Abdelghani, Y. Miyazaki, E.W. Holy, C. Merten, D. Zachow, W.A.L. Tonino, M.C.M. Rutten, F.N. van de Vosse, M.A. Morel, Y. Onuma, P.W. Serruys, G. Richardt, O.I. Soliman

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Abstract

Objectives: This study sought to compare a new quantitative angiographic technique to cardiac magnetic resonance-derived regurgitation fraction (CMR-RF) for the quantification of prosthetic valve regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). Background: PVR after TAVR is challenging to quantify, especially during the procedure. Methods: Post-replacement aortograms in 135 TAVR recipients were analyzed offline by videodensitometry to measure the ratio of the time-resolved contrast density in the left ventricular outflow tract to that in the aortic root (videodensitometric aortic regurgitation [VD-AR]). CMR was performed within an interval of ≤30 days (11 ± 6 days) after the procedure. Results: The average CMR-RF was 6.7 ± 7.0% whereas the average VD-AR was 7.0 ± 7.0%. The correlation between VD-AR and CMR-RF was substantial (r = 0.78, p < 0.001). On receiver-operating characteristic curves, a VD-AR ≥10% corresponded to >mild PVR as defined by CMR-RF (area under the curve: 0.94; p < 0.001; sensitivity 100%, specificity 83%), whereas a VD-AR ≥25% corresponded to moderate-to-severe PVR (area under the curve: 0.99; p = 0.004; sensitivity 100%, specificity 98%). Intraobserver reproducibility was excellent for both techniques (for CMR-RF, intraclass correlation coefficient: 0.91, p < 0.001; for VD-AR intraclass correlation coefficient: 0.93, p < 0.001). The difference on rerating was –0.04 ± 7.9% for CMR-RF and –0.40 ± 6.8% for VD-AR. Conclusions: The angiographic VD-AR provides a surrogate assessment of PVR severity after TAVR that correlates well with the CMR-RF.

Original languageEnglish
Pages (from-to)287-297
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume11
Issue number3
DOIs
Publication statusPublished - 12 Feb 2018

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Keywords

  • angiography
  • aortic valve
  • magnetic resonance
  • regurgitation
  • stenosis
  • transcatheter
  • Predictive Value of Tests
  • Humans
  • Male
  • Transcatheter Aortic Valve Replacement/adverse effects
  • Aged, 80 and over
  • Female
  • Densitometry
  • Radiographic Image Interpretation, Computer-Assisted
  • Severity of Illness Index
  • Mitral Valve Insufficiency/diagnostic imaging
  • Reproducibility of Results
  • Heart Valve Prosthesis
  • Mitral Valve/diagnostic imaging
  • Risk Factors
  • Treatment Outcome
  • Magnetic Resonance Imaging
  • Aged
  • Aortography/methods
  • Aortic Valve/diagnostic imaging
  • Observer Variation

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