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 language | English |
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Pages (from-to) | 287-297 |
Number of pages | 11 |
Journal | JACC: Cardiovascular Interventions |
Volume | 11 |
Issue number | 3 |
DOIs | |
Publication status | Published - 12 Feb 2018 |
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