Author + information
- Received April 5, 2012
- Accepted April 12, 2012
- Published online August 1, 2012.
- Mariuca Vasa-Nicotera, MD⁎,
- Jan-Malte Sinning, MD⁎,
- Derek Chin, MD†,
- Tiong Keng Lim, MD†,
- Tomasz Spyt, MD†,
- Hasan Jilaihawi, MD†,
- Eberhard Grube, MD⁎,
- Nikos Werner, MD⁎,
- Georg Nickenig, MD⁎ and
- Jan Kovac, MD†,⁎ ()
- ↵⁎Reprint requests and correspondence
: Dr. Jan Kovac, Department of Cardiology, Glenfield University Hospital, Groby Road, Leicester LE3 9QP, United Kingdom
Objectives The aim of this study was to evaluate the performance of the aortic regurgitation (AR) index as a new hemodynamic parameter in an independent transcatheter aortic valve implantation (TAVI) cohort and validate its application.
Background Increasing evidence associates more-than-mild periprosthetic aortic regurgitation (periAR) with increased mortality and morbidity; therefore precise evaluation of periAR after TAVI is essential. The AR index has been proposed recently as a simple and reproducible indicator for the severity of periAR and predictor of associated mortality.
Methods The severity of periAR was evaluated by echocardiography, angiography, and periprocedural measurement of the dimensionless AR index = ([diastolic blood pressure − left ventricular end-diastolic pressure]/systolic blood pressure) × 100. A cutoff value of 25 was used to identify patients at risk.
Results One hundred twenty-two patients underwent TAVI by use of either the Medtronic CoreValve (Medtronic, Minneapolis, Minnesota) (79.5%) or the Edwards-SAPIEN bioprosthesis (Edwards Lifesciences, Irvine, California) (20.5%). The AR index decreased stepwise from 29.4 ± 6.3 in patients without periAR (n = 26) to 28.0 ± 8.5 with mild periAR (n = 76), 19.6 ± 7.6 with moderate periAR (n = 18), and 7.6 ± 2.6 with severe periAR (n = 2) (p < 0.001). Patients with AR index <25 had a significantly increased 1-year mortality rate compared with patients with AR index ≥25 (42.3% vs. 14.3%; p < 0.001). Even in patients with none/mild periAR, the 1-year mortality risk could be further stratified by an AR index <25 (31.3% vs. 14.3%; p = 0.04).
Conclusions The validity of the AR index could be confirmed in this independent TAVI cohort and provided prognostic information that was complementary to the severity of AR.
Dr. Jilaihawi is a consultant for Edwards Lifesciences, St. Jude Medical, and Venus Medtech. Dr. Grube is proctor for CoreValve/Medtronic. Dr. Kovac is proctor for CoreValve/Medtronic and Edwards-SAPIEN. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Vasa-Nicotera and Sinning contributed equally to this work.
- Received April 5, 2012.
- Accepted April 12, 2012.
- American College of Cardiology Foundation