Author + information
- Received July 20, 2017
- Revision received August 24, 2017
- Accepted August 29, 2017
- Published online February 5, 2018.
- Mohamed Abdel-Wahab, MDa,
- Mohammad Abdelghani, MD, MScb,
- Yosuke Miyazaki, MD, PhDc,
- Erik W. Holy, MD, PhDa,
- Constanze Merten, MDa,
- Dirk Zachow, MDd,
- Pim Tonino, MD, PhDe,
- Marcel C.M. Rutten, PhDf,
- Frans N. van de Vosse, PhDf,
- Marie-Angele Morel, MScg,
- Yoshinobu Onuma, MD, PhDc,g,
- Patrick W. Serruys, MD, PhDh,∗ (, )
- Gert Richardt, MD, PhDa and
- Osama I. Soliman, MD, PhDc,g,∗∗ ()
- aDepartment of Cardiology, Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
- bDepartment of Cardiology, the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- cDepartment of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
- dDepartment of Radiology, Segeberger Kliniken GmbH, Bad Segeberg, Germany
- eDepartment of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
- fDepartment of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- gCardialysis Clinical Trials Management and Core Laboratories, Rotterdam, the Netherlands
- hInternational Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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.
Dr. Abdel-Wahab has received institutional research grants from Biotronik and St. Jude Medical; and has served as a consultant and proctor for Boston Scientific. Dr. Holy has received a training grant from the European Association of Percutaneous Cardiovascular Interventions sponsored by Edwards Lifesciences; and a research grant from the Walter and Gertrud Siegenthaler Foundation of the University of Zurich, Switzerland. Dr. Richardt has received institutional research grants from Biotronik and St. Jude Medical. Dr. Soliman has served as the Cardialysis Echo Core Laboratory Chairman for a number of trials for which he receives no direct compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Abdel-Wahab and Abdelghani contributed equally to this work.
- Received July 20, 2017.
- Revision received August 24, 2017.
- Accepted August 29, 2017.
- 2018 American College of Cardiology Foundation
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