Aortic Regurgitation Index Ratio Is a Strong Predictor of 1-Year Mortality After Transcatheter Aortic Valve Implantation Using Self-Expanding Devices

Wely, Marleen van; Wulp, Kees van der; Rooijakkers, Maxim J.P.; Vart, Priya; Morshuis, Wim J.; Royen, Niels van; Gehlmann, Helmut; Kievit, Peter C.; Garsse, Leen van; Geuzebroek, Guillaume S.C.

doi:10.1053/j.semtcvs.2020.11.025

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…Previously, we showed that ARI ratio < 0.6 is the strongest haemodynamic predictor of 1-year mortality after TAVR. 36 In the present study, interestingly ARI ratio was least predictive for the occurrence of CMR-RF > 20%. Indeed, for clinical outcome not only the post-TAVR occurrence of PVR is important but also the pre-TAVR haemodynamic circumstances like diastolic dysfunction and pre-existing aortic regurgitation.…”

Section: Discussionsupporting

confidence: 41%

Diastolic delta best predicts paravalvular regurgitation after transcatheter aortic valve replacement as assessed by cardiac magnetic resonance: the APPOSE trial

Rooijakkers¹,

Stens²,

Wely³

et al. 2023

European Heart Journal - Cardiovascular Imaging

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Aims Paravalvular regurgitation (PVR) is a common complication after transcatheter aortic valve replacement (TAVR) that poses an increased risk of rehospitalization for heart failure and mortality. The aim of this study was to assess the accuracy of haemodynamic indices to predict relevant PVR. Methods and results In this prospective single-centre clinical trial, four haemodynamic indices of PVR measured during TAVR were assessed for their correlation with gold standard cardiac magnetic resonance (CMR)-derived regurgitant fraction (CMR-RF) at 1 month follow-up: diastolic delta (DD), heart rate-adjusted diastolic delta (HR-DD), aortic regurgitation index (ARI), and aortic regurgitation index ratio (ARI ratio). These haemodynamic indices were analysed for their ability to predict relevant PVR (defined as CMR-RF > 20%) using receiver operating characteristic (ROC) curves with corresponding area under the ROC curves (AUCs). A total of 77 patients were included and had CMR performed 41 ± 14 days after TAVR. Mean CMR-RF was 12.4 ± 9.3%. Fifteen (19.5%) patients had CMR-RF > 20%. DD had the best correlation with CMR-RF and the highest AUC to predict relevant PVR (0.82; 95% CI, 0.72–0.92), followed by HR-DD (AUC 0.78; 95% CI, 0.67–0.89), ARI (AUC 0.78; 95% CI, 0.66–0.89), and ARI ratio (AUC 0.65; 95% CI, 0.49–0.81). The optimal cut-off value for DD was 32 mmHg, with sensitivity of 69% and specificity of 77% in predicting relevant PVR. Conclusion DD measured during TAVR best predicts relevant PVR. Correction for heart rate (HR-DD) or systolic blood pressure (ARI, ARI ratio) did not improve this predictive value.

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Section: Discussionsupporting

confidence: 41%

Diastolic delta best predicts paravalvular regurgitation after transcatheter aortic valve replacement as assessed by cardiac magnetic resonance: the APPOSE trial

Rooijakkers¹,

Stens²,

Wely³

et al. 2023

European Heart Journal - Cardiovascular Imaging

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“…Several previous studies have assessed the impact of hemodynamic indices on prognosis after TAVI. With the majority of studies showing a significant association with survival [14,[22][23][24][25], two investigations from the same centre recently suggested contradictory findings regarding short-and long-term outcomes on mortality [26,27]. However, to our knowledge, only one study showed the impact of a time-integrated aortic regurgitation index (TIARI) on PVL requiring PD [9].…”

Section: Discussionmentioning

confidence: 99%

Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation

Uebelacker,

Martin,

Vasa-Nicotera

et al. 2023

JCM

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Background and aim: Tools that assist interventionists in selecting patients for post-dilation (PD) are needed. We aimed to assess whether pre-interventional aortic valve calcium (AVC) or the peri-interventional aortic regurgitation (ARI) ratio is a better predictor for a more than mild paravalvular leak (PVL) requiring PD after TAVI. Methods: Patients undergoing TAVI with available data on AVC derived from MSCTs and the ARI ratio derived from peri-interventional hemodynamic curves were studied. The main outcome was moderate-to-severe PVL requiring PD. Results: In 237 patients, more than mild PVL after valve deployment was present in 25.7%. PD was performed in 65 patients. The median (IQR) total AVC was 390.5 (211.5–665.4) mm3. All calcification values were significantly higher in patients who underwent PD. The median (IQR) individual threshold was 600 (550–685) Hus. The overall ARI ratio was 0.78 (0.61–0.96), with values being significantly lower in patients who underwent PD: 0.61 (0.49–0.80) vs. 0.82 (0.69–0.99) (p < 0.001). Both the ARI ratio (OR [95%CI] 0.053 [0.014–0.203]; p < 0.001) and AVC (1.01 [1.000–1.002]; p = 0.015) predicted PD need. ROC curves showed higher discrimination for the ARI ratio (AUC 0.73) than for any calcification parameter (all AUCs ≤ 0.62). Conclusions: The ARI ratio provides interventionists with a powerful predictive tool for PVL requiring PD after TAVI that is beyond the predictive value of pre-procedural valve calcification derived from MSCT.

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“…24 In contrast, this is almost entirely absent in conventional valve implantation as our study and other papers show. 17 Paravalvular leakage increases the risk of premature death as TAVI data indicate, 25 and it is a risk for the development of an endocarditis, as well as anemia, owing to chronic hemolysis. 26 It can be speculated that it is too early for these problems to be revealed in studies dealing with low-risk patients for being elusive in the early period.…”

Section: Discussionmentioning

confidence: 99%

Results of Four-Stented Biological Aortic Valves and How They Compare to PARTNER-3

Rashvand

Ostovar

Schröter

et al. 2022

Thorac Cardiovasc Surg

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Objective According to our nationwide registry, total numbers of surgical aortic valve implantation (sAVR) are constantly declining, while transcathether aortic valve implantation (TAVI) indications are widened toward intermediate- and low-risk patients. So, is there still room for conventionally implanted valves? Can results compete with TAVI or will sAVR be marginalized in the near future? Methods Between 2011 and 2019, 1,034 patients (67.1% male, mean = 72.2 years) were enrolled receiving stented biological valves with or without concomitant coronary artery bypass grafting (CABG), atrial ablation, or wrapping of the ascending aorta. Odds ratios for the early and late mortality were calculated regarding comorbidities as potential risk factors. Statistical analysis was performed using SPSS. Results Overall, early mortality (EM) was 6.1%, 1-year mortality was 11.2%, and 5-year mortality was 19.9%. In low-risk patients (EuroSCORE II <4%), it was 1.0, 2.7, and 9.3%. Incidence of EM was significantly increased following decompensation, prosthetic valve, pacemaker carrier, dialysis, and pulmonary hypertension. Postoperative complications, such as systemic inflammatory response syndrome (SIRS), sepsis, multiorgan failure, hepatic failure, dialysis, gastrointestinal bleeding, and ileus, also increased EM. Late mortality was significantly increased by dialysis, hepatic cirrhosis, infected port system, aortic valve endocarditis, prosthetic valve carrier, and chronic hemodialysis. Conclusion Conventionally implanted aortic valves do well early and late. The fate of the patient is dependent on individual risk-factors. Particularly, in low-risk patients, sAVR can compete with TAVI showing overall good early, as well as late results being even superior in some important aspects such as pacemaker implantation rate. Thus, the time is yet not ripe for TAVI to take over primary indications for AVR in low-risk patient.

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Aortic Regurgitation Index Ratio Is a Strong Predictor of 1-Year Mortality After Transcatheter Aortic Valve Implantation Using Self-Expanding Devices

Abstract: Index ratio is a strong predictor of one-year mortality after transcatheter aortic valve implantation using self-expanding devices,

Cited by 8 publications

References 39 publications

Diastolic delta best predicts paravalvular regurgitation after transcatheter aortic valve replacement as assessed by cardiac magnetic resonance: the APPOSE trial

Diastolic delta best predicts paravalvular regurgitation after transcatheter aortic valve replacement as assessed by cardiac magnetic resonance: the APPOSE trial

Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation

Results of Four-Stented Biological Aortic Valves and How They Compare to PARTNER-3

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