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 (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.
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 (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.
KW - aortic stenosis
KW - imaging modalities
KW - paravalvular leak
KW - transcatheter aortic valve implantation (TAVI)
KW - Severity of Illness Index
KW - Predictive Value of Tests
KW - Models, Cardiovascular
KW - Humans
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Prosthesis Design
KW - Heart Valve Prosthesis/adverse effects
KW - Densitometry
KW - Hemodynamics
KW - Aortography/methods
KW - Aortic Valve Insufficiency/diagnostic imaging
KW - Aortic Valve/diagnostic imaging
KW - Radiographic Image Interpretation, Computer-Assisted/methods
KW - Models, Anatomic
UR - http://www.scopus.com/inward/record.url?scp=85041695031&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-17-00595
DO - 10.4244/EIJ-D-17-00595
M3 - Article
C2 - 28994656
SN - 1774-024X
VL - 13
SP - 1527
EP - 1535
JO - EuroIntervention
JF - EuroIntervention
IS - 13
ER -