Haemodynamic evaluation of aortic regurgitation after transcatheter aortic valve implantation using cardiovascular magnetic resonance

Sherif, Mohammad; Abdel‐Wahab, Mohamed; Beurich, Hans-Wilko; Stöcker, Björn; Zachow, Dirk; Geist, Volker; Tölg, Ralph; Richardt, Gert

doi:10.4244/eijv7i8a12

Cited by 93 publications

(54 citation statements)

References 20 publications

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“…In contrast, by using flow measurements by cardiac MRI, a quantitative assessment of AR is possible, which is independent of the number or eccentricity of the regurgitant jets. 17 Another possible explanation for the increasing AR might be a higher compliance of the left ventricle attributable to the dwindling of LV mass after TAVI. This could also explain why this increase of AR was not observed after shorter periods of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…24 In addition, we demonstrated in a previous study that conventional TTE has its limitations in detecting and quantifying post-TAVI AR compared with MRI. 17 The limitations of TTE have been recently highlighted in the European Association of Echocardiography/American Society of Echocardiography recommendations for the use of Data presented as mean±SD or median and range. P value obtained by using either the paired Student t test or the Wilcoxon signed-rank test according to the distribution of the change in value.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] Compared with the evaluation of AR by echocardiography, MRI is more sensitive in patients with paravalvular, eccentric, or multiple jets like those frequently observed after TAVI. 17 We therefore sought to evaluate LV function, LV remodeling, and the occurrence and evolution of AR in the early and medium-term follow-up after TAVI by using serial cardiac MRI.…”

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confidence: 99%

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Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Merten

Beurich

Zachow

et al. 2013

Circ: Cardiovascular Interventions

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all patients treated with TAVI at our institution were screened for inclusion into this prospective study (n=170; Figure 1). Indication for TAVI was in concordance with the recent consensus statement.18 Data collection was approved by the Institutional Review Board, and all patients signed an informed written consent. Patients with a contraindication to MRI (eg, pre-or post-TAVI pacemakers or MRI incompatible implants) and patients with claustrophobia, severe arrhythmias, or unstable clinical conditions were excluded from the study. Ultimately, a total of 55 consecutive patients treated with TAVI with the use of the 2 currently commercially available bioprostheses (Medtronic CoreValve, Background-Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) has been associated with poor outcomes, but little is known about how it evolves over time. We evaluated left ventricular (LV) function, remodeling, and the occurrence and evolution of AR after TAVI by using cardiac MRI. Methods and Results-Forty-three patients treated with transfemoral TAVI underwent cardiac MRI 1 week and 6 months after TAVI. LV volumes and function were assessed by using standard cine MRI sequences. Phase-contrast imaging was performed to quantify the degree of AR. The mean age of the evaluated patients was 80 years, and 65% of patients were women. At baseline MRI, the median LV ejection fraction was 58.1%, which improved significantly at follow-up to 63.4% (P<0.0001). A significant reduction of LV end-diastolic volume (149.7±41.4-140.1±43.9 mL; P=0.014) and of LV mass (156.3±32.8-142.7±39.3 g; P<0.001) was observed. Over time, aortic regurgitant fraction increased slightly but significantly from 5.2% to 7.8% (P=0.04). Subgroup analysis revealed that significant changes of LV ejection fraction, volumes, and mass only occurred in patients with no or mild AR at baseline MRI, whereas those parameters remained unchanged in patients with AR more than or equal to grade II. Conclusions-By using cardiac MRI in patients with TAVI, a significant improvement of LV function, volume, and mass can be documented. Mild-to-moderate AR is commonly seen, and AR shows a small increase over time. More-than-mild AR seems to prevent LV functional and structural recovery after TAVI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Merten

Beurich

Zachow

et al. 2013

Circ: Cardiovascular Interventions

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“…Residual PAR was graded qualitatively after final device deployment and catheter removal by the amount of regurgitant contrast media during supraaortic angiography, using the Sellers criteria (1,18,19): absence of PAR ϭ 0/4, mild ϭ 1/4, moderate ϭ 2/4, moderate to severe ϭ 3/4, and severe PAR ϭ 4/4. LV and aortic pressures were simultaneously measured after the procedure.…”

Section: Methodsmentioning

confidence: 99%

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

Patsalis

Konorza

Al–Rashid

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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P. Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality. Am J Physiol Heart Circ Physiol 304: H1023-H1028, 2013. First published January 11, 2013; doi:10.1152/ajpheart.00807.2012.-A relevant (at least moderate) paravalvular regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is found in up to 20% of cases and associated with increased mortality. The ratio of the diastolic over the systolic pressure time integral (DPTI:SPTI) has been proposed to reflect an estimate of myocardial oxygen supply versus demand and the propensity for myocardial ischemia. We have now evaluated the potential of this ratio to predict PAR-associated cardiovascular mortality after TAVI, retrospectively analyzing data from 167 consecutive TAVI patients. PAR was graded angiographically, and the myocardial supply-demand ratio was estimated from the planimetric integration of the diastolic and systolic pressure-time area (DPTI and SPTI), respectively. PAR was observed in 113 patients (67%) and angiographically graded as mild in 89 (78.8%), moderate in 21 (18.6%) or moderate to severe in 3 (2.7%) cases. The DPTI:SPTI ratio decreased with increasing Sellers grade of PAR (P Ͻ 0.001). A DPTI:SPTI of Յ0.7 predicted cardiovascular mortality (area under the curve ϭ 0.96). Cardiovascular mortality at 30 days and 1 yr was increased in patients with DPTI:SPTI Յ 0.7 over those with DPTI:SPTI Ͼ 0.7 (42 vs. 2% and 63 vs. 3%, respectively; P Ͻ 0.001). In conclusion, DPTI:SPTI provides an excellent cutoff value of Յ0.7 for the prediction of PAR-associated mortality. aortic regurgitation; aortic stenosis; transcatheter aortic valve implantation.THE INCIDENCE OF moderate and severe paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) varies from 10 to 20% (4,5,17,(21)(22)(23)27), and moderate-to-severe PAR after TAVI is associated with increased in-hospital mortality and unfavorable long-term outcome (1,11,14,20). PAR severity during TAVI is usually graded qualitatively using angiography. Quantitative evaluation of PAR has been recently proposed by use of the aortic regurgitation (AR) index, which is calculated as the ratio of the gradient between diastolic aortic pressure (DAP) and left ventricular (LV) end-diastolic pressure (LVEDP) to systolic blood pressure (SBP) ϫ 100 or [(DAP-LVEDP)/SBP] ϫ 100 (20) or more simply by use of the pressure difference between DAP and LVEDP (⌬P DAP-LVEDP ) (14). A pathophysiological understanding of PAR and its consequences is a prerequisite for an effective treatment and the improvement of survival.Myocardial ischemia is traditionally viewed as an imbalance of myocardial oxygen supply over demand. Such supplydemand ratio can be estimated from the ratio of the diastolic over systolic pressure time integral (DPTI:SPTI), which sensitively reflects the propensity to myocardial ischemia, notably subendocardial ischemia (7,8). Aortic regurgitation is typically associated with a reduce...

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“…Intertechnique reproducibility is imperfect. 91,99 Moreover, the VARC-proposed cut points defining AR severity are either not well-validated 100 or extrapolated from echocardiographic experience in native AR. Establishing a consensus on how to best detect and quantitate regurgitation after TAVI should go side by side with the improvements in antileak technologies before TAVI can be regarded as default therapy in younger, lower-risk patients.…”

Section: Aortic Regurgitationmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

Abdelghani

Serruys

2016

Circ: Cardiovascular Interventions

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Abstract-Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients' risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report. (Circ Cardiovasc Interv. 2016;9:e002944.

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Haemodynamic evaluation of aortic regurgitation after transcatheter aortic valve implantation using cardiovascular magnetic resonance

Cited by 93 publications

References 20 publications

Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

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