Author + information
- Received September 25, 2015
- Revision received December 7, 2015
- Accepted December 17, 2015
- Published online April 11, 2016.
- Jan-Malte Sinning, MDa,∗ (, )
- Anja Stundl, MDa,
- Simon Pingel, MDa,
- Marcel Weber, MDa,
- Alexander Sedaghat, MDa,
- Christoph Hammerstingl, MDa,
- Mariuca Vasa-Nicotera, MDa,
- Fritz Mellert, MDb,
- Wolfgang Schiller, MDb,
- Jan Kovac, MDc,d,
- Armin Welz, MDb,
- Eberhard Grube, MDa,
- Nikos Werner, MDa and
- Georg Nickenig, MDa
- aHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- bHeart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
- cDepartment of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- dNIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Jan-Malte Sinning, Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany.
Objectives The aims of this study were to increase the discriminatory value of the aortic regurgitation index (ARI) for the assessment of paravalvular regurgitation (PVR) and to further elucidate the association between aortic regurgitation severity and mortality after transcatheter aortic valve replacement (TAVR).
Background Hemodynamic parameters such as the ARI complement predominantly angiographically guided TAVR. However, the ARI depends on several baseline and periprocedural characteristics.
Methods The ARI was prospectively calculated before and after TAVR in 600 patients. The severity of PVR was assessed in all patients by angiography and echocardiography according to a 3-class scheme. To account for pre-procedural hemodynamic status, the ARI ratio was calculated as post- over pre-procedural ARI.
Results Apart from the degree of PVR (β = −0.396, p < 0.001), pre-procedural hemodynamic status in the form of the ARI before TAVR (β = 0.227, p < 0.001) was associated with post-procedural ARI in multivariate regression analysis. The ARI ratio increased the specificity of post-procedural ARI alone for the prediction of both more than mild PVR and 1-year mortality from 75.1% to 93.2% and from 75.0% to 93.3%, respectively. Patients with post-procedural ARI values <25 after TAVR had significantly increased 1-year mortality only when the ARI ratio was <0.60 (50.0% vs. 26.3%, p = 0.001).
Conclusions The ARI ratio integrating pre- and post-procedural hemodynamic status increases the discriminatory value of post-procedural ARI. The ARI ratio, which reflects acute hemodynamic changes after TAVR, is useful to identify patients with negative outcomes.
Drs. Sinning, Werner, and Nickenig have received speaker honoraria and research grants from Medtronic, Edwards Lifesciences, Direct Flow Medical, and Boston Scientific. Dr. Hammerstingl received speaker honoraria from Medtronic. Dr. Mellert received speaker honoraria and is proctor for Medtronic. Dr. Grube received speaker honoraria and is proctor for Medtronic and Boston. Dr. Kovac is a consultant to Medtronic and St. Jude Medical; and is a proctor for Medtronic, Edwards Lifesciences, and Boston. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 25, 2015.
- Revision received December 7, 2015.
- Accepted December 17, 2015.
- American College of Cardiology Foundation