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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Aortic Valve Insufficiency
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Area Under Curve
Sensitivity and Specificity
Transcatheter Aortic Valve Replacement

Keywords

  • angiography
  • aortic valve
  • magnetic resonance
  • regurgitation
  • stenosis
  • transcatheter

Cite this

Abdel-Wahab, M. ; Abdelghani, M. ; Miyazaki, Y. ; Holy, E.W. ; Merten, C. ; Zachow, D. ; Tonino, W.A.L. ; Rutten, M.C.M. ; van de Vosse, F.N. ; Morel, M.A. ; Onuma, Y. ; Serruys, P.W. ; Richardt, G. ; Soliman, O.I. / A novel angiographic quantification of aortic regurgitation after TAVR provides an accurate estimation of regurgitation fraction derived from cardiac magnetic resonance imaging. In: JACC: Cardiovascular Interventions. 2018 ; Vol. 11, No. 3. pp. 287-297.
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title = "A novel angiographic quantification of aortic regurgitation after TAVR provides an accurate estimation of regurgitation fraction derived from cardiac magnetic resonance imaging",
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.",
keywords = "angiography, aortic valve, magnetic resonance, regurgitation, stenosis, transcatheter",
author = "M. Abdel-Wahab and M. Abdelghani and Y. Miyazaki and E.W. Holy and C. Merten and D. Zachow and W.A.L. Tonino and M.C.M. Rutten and {van de Vosse}, F.N. and M.A. Morel and Y. Onuma and P.W. Serruys and G. Richardt and O.I. Soliman",
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Abdel-Wahab, M, Abdelghani, M, Miyazaki, Y, Holy, EW, Merten, C, Zachow, D, Tonino, WAL, Rutten, MCM, van de Vosse, FN, Morel, MA, Onuma, Y, Serruys, PW, Richardt, G & Soliman, OI 2018, 'A novel angiographic quantification of aortic regurgitation after TAVR provides an accurate estimation of regurgitation fraction derived from cardiac magnetic resonance imaging', JACC: Cardiovascular Interventions, vol. 11, no. 3, pp. 287-297. https://doi.org/10.1016/j.jcin.2017.08.045

A novel angiographic quantification of aortic regurgitation after TAVR provides an accurate estimation of regurgitation fraction derived from cardiac magnetic resonance imaging. / Abdel-Wahab, M.; Abdelghani, M.; Miyazaki, Y.; Holy, E.W.; Merten, C.; Zachow, D.; Tonino, W.A.L.; Rutten, M.C.M.; van de Vosse, F.N.; Morel, M.A.; Onuma, Y.; Serruys, P.W.; Richardt, G.; Soliman, O.I.

In: JACC: Cardiovascular Interventions, Vol. 11, No. 3, 12.02.2018, p. 287-297.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - A novel angiographic quantification of aortic regurgitation after TAVR provides an accurate estimation of regurgitation fraction derived from cardiac magnetic resonance imaging

AU - Abdel-Wahab, M.

AU - Abdelghani, M.

AU - Miyazaki, Y.

AU - Holy, E.W.

AU - Merten, C.

AU - Zachow, D.

AU - Tonino, W.A.L.

AU - Rutten, M.C.M.

AU - van de Vosse, F.N.

AU - Morel, M.A.

AU - Onuma, Y.

AU - Serruys, P.W.

AU - Richardt, G.

AU - Soliman, O.I.

PY - 2018/2/12

Y1 - 2018/2/12

N2 - 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.

AB - 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.

KW - angiography

KW - aortic valve

KW - magnetic resonance

KW - regurgitation

KW - stenosis

KW - transcatheter

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