Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation.

M. Abdelghani, Y. Miyazaki, E.S. de Boer, J.P. Aben, M. van Sloun, T. Suchecki, M. van 't Veer, O.I.I. Soliman, Y. Onuma, R. de Winter, P. Tonino, F.N. van de Vosse, M.C.M. Rutten, P.W. Serruys

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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 (r2=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 (r2=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: r2=0.85 and r2=0.83; four cycles: r2=0.96 and r2=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 languageEnglish
Pages (from-to)1527-1535
JournalEuroIntervention
Volume13
Issue number13
DOIs
Publication statusPublished - 20 Jan 2018

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Aortic Valve Insufficiency
Aortic Valve
Heart Ventricles
Aortography
Specific Gravity
In Vitro Techniques

Keywords

  • aortic stenosis
  • imaging modalities
  • paravalvular leak
  • transcatheter aortic valve implantation (TAVI)

Cite this

Abdelghani, M., Miyazaki, Y., de Boer, E. S., Aben, J. P., van Sloun, M., Suchecki, T., ... Serruys, P. W. (2018). Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation. EuroIntervention, 13(13), 1527-1535. https://doi.org/10.4244/EIJ-D-17-00595
Abdelghani, M. ; Miyazaki, Y. ; de Boer, E.S. ; Aben, J.P. ; van Sloun, M. ; Suchecki, T. ; van 't Veer, M. ; Soliman, O.I.I. ; Onuma, Y. ; de Winter, R. ; Tonino, P. ; van de Vosse, F.N. ; Rutten, M.C.M. ; Serruys, P.W. / Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation. In: EuroIntervention. 2018 ; Vol. 13, No. 13. pp. 1527-1535.
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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 (r2=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 (r2=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: r2=0.85 and r2=0.83; four cycles: r2=0.96 and r2=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.",
keywords = "aortic stenosis, imaging modalities, paravalvular leak, transcatheter aortic valve implantation (TAVI)",
author = "M. Abdelghani and Y. Miyazaki and {de Boer}, E.S. and J.P. Aben and {van Sloun}, M. and T. Suchecki and {van 't Veer}, M. and O.I.I. Soliman and Y. Onuma and {de Winter}, R. and P. Tonino and {van de Vosse}, F.N. and M.C.M. Rutten and P.W. Serruys",
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Abdelghani, M, Miyazaki, Y, de Boer, ES, Aben, JP, van Sloun, M, Suchecki, T, van 't Veer, M, Soliman, OII, Onuma, Y, de Winter, R, Tonino, P, van de Vosse, FN, Rutten, MCM & Serruys, PW 2018, 'Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation.', EuroIntervention, vol. 13, no. 13, pp. 1527-1535. https://doi.org/10.4244/EIJ-D-17-00595

Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation. / Abdelghani, M.; Miyazaki, Y.; de Boer, E.S.; Aben, J.P.; van Sloun, M.; Suchecki, T.; van 't Veer, M.; Soliman, O.I.I.; Onuma, Y.; de Winter, R.; Tonino, P.; van de Vosse, F.N.; Rutten, M.C.M.; Serruys, P.W.

In: EuroIntervention, Vol. 13, No. 13, 20.01.2018, p. 1527-1535.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation.

AU - Abdelghani, M.

AU - Miyazaki, Y.

AU - de Boer, E.S.

AU - Aben, J.P.

AU - van Sloun, M.

AU - Suchecki, T.

AU - van 't Veer, M.

AU - Soliman, O.I.I.

AU - Onuma, Y.

AU - de Winter, R.

AU - Tonino, P.

AU - van de Vosse, F.N.

AU - Rutten, M.C.M.

AU - Serruys, P.W.

PY - 2018/1/20

Y1 - 2018/1/20

N2 - 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 (r2=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 (r2=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: r2=0.85 and r2=0.83; four cycles: r2=0.96 and r2=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.

AB - 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 (r2=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 (r2=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: r2=0.85 and r2=0.83; four cycles: r2=0.96 and r2=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.

KW - aortic stenosis

KW - imaging modalities

KW - paravalvular leak

KW - transcatheter aortic valve implantation (TAVI)

U2 - 10.4244/EIJ-D-17-00595

DO - 10.4244/EIJ-D-17-00595

M3 - Article

C2 - 28994656

VL - 13

SP - 1527

EP - 1535

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 13

ER -