Abstract
Aims: Videodensitometric assessment of aortography provides a periprocedural quantitation of prosthetic valve regurgitation (PVR) after transcatheter aortic valve implantation. We sought to compare the videodensitometric parameters of PVR severity to the regurgitation fraction (RF) in a controlled in vitro setting. Methods and results: In a mock circulation system, a transcatheter balloon-expandable valve inserted at the aortic valve position was gradually deformed to induce different grades of paravalvular leakage and the RF was measured with a transonic flow probe. Contrast aortography was performed and the following videodensitometric parameters were generated: left ventricle aortic regurgitation (LV-AR), LV outflow tract AR (LVOT-AR), quantitative regurgitation assessment (qRA) index, relative maximum density (relative max), and maximum upslope of the LV time-density curve. The correlation was substantial between videodensitometric parameters (LV-AR, LVOT-AR, qRA index, relative max, and maximum upslope) and RF (r 2=0.96, 0.96, 0.93, 0.87, and 0.93; p<0.001 for all). LV-AR (region of interest [ROI]=entire LV) and LVOT-AR (ROI=LVOT) were not different (p=0.51) and were strongly correlated (r 2=0.99) with a mean difference of 1.92% (95% limits of agreement: ±2.83). The correlations of LV-AR and LVOT-AR with RF were stronger when more than one cardiac cycle was included in the analysis (one cycle: r 2=0.85 and r 2=0.83; four cycles: r 2=0.96 and r 2=0.96, for LV-AR and LVOT-AR, respectively). Including more cycles beyond four did not improve accuracy. Conclusions: Quantitative assessment of PVR by videodensitometry of aortograms strongly correlates with the actual RF in a controlled in vitro setting. Accuracy is improved by including more than one cardiac cycle in the analysis.
Original language | English |
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Pages (from-to) | 1527-1535 |
Number of pages | 9 |
Journal | EuroIntervention |
Volume | 13 |
Issue number | 13 |
DOIs | |
Publication status | Published - 20 Jan 2018 |
Keywords
- aortic stenosis
- imaging modalities
- paravalvular leak
- transcatheter aortic valve implantation (TAVI)
- Severity of Illness Index
- Predictive Value of Tests
- Models, Cardiovascular
- Humans
- Transcatheter Aortic Valve Replacement/adverse effects
- Prosthesis Design
- Heart Valve Prosthesis/adverse effects
- Densitometry
- Hemodynamics
- Aortography/methods
- Aortic Valve Insufficiency/diagnostic imaging
- Aortic Valve/diagnostic imaging
- Radiographic Image Interpretation, Computer-Assisted/methods
- Models, Anatomic