Mohammad Abdelghani1, Hiroki Tateishi2, Ernest Spitzer3, Jan G Tijssen1, Robbert J de Winter1, Osama I I Soliman4, Rebecca T Hahn5, Patrick W Serruys6. 1. Academic Medical center, Amsterdam, The Netherlands. 2. Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. 3. Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands. 4. Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands. 5. Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA. 6. International Centre for Circulatory Health, NHLI, Imperial College London, London, UK patrick.w.j.c.serruys@gmail.com.
Abstract
AIMS: Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is often first diagnosed by angiography and then confirmed and followed-up by transthoracic echocardiography (TTE). Consistency between both methods is important for follow-up. We sought to determine inter-technique reproducibility of the assessment of paravalvular AR after TAVI. METHODS AND RESULTS: The study included 165 patients treated with a self-expanding bioprosthesis and had angiography and TTE performed at a median interval of 4 days. TTE parameters of AR severity included VARC score (the average AR grade determined by the echocardiographic VARC-II criteria), pressure half time (PHT), regurgitation jet features in long-axis views (LAX score) and colour Doppler (CD) score (=paravalvular AR jet circumferential extent (%) + LAX score). Using receiver-operating characteristics curves, the cut-points that best defined an angiographic >mild AR were identified.On TTE, AR was paravalvular in all cases, multi-jet in 28%, and predominantly (64%) detected in the commissural region between the right and left coronary sinuses. Using VARC-II criteria (combining at least two), TTE agreed with angiographic classification in 53% of cases (k = 0.14). Greater than mild AR could better be defined by one of the following combinations of criteria: (i) LAX score >4.25 and VARC-II score >1.33; (ii) CD score >11.5 and PHT <400 ms. The combination of the CD score with PHT gave the best sum of sensitivity, specificity, positive, and negative predictive values. CONCLUSIONS: Agreement between angiography and TTE (using the VARC-II criteria) in the grading of post-TAVI AR is modest, and this might have contributed to the inconsistency of data on the rate and fate of paravalvular AR. Inter-technique reproducibility can be improved using a combination of CD and hemodynamic parameters. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is often first diagnosed by angiography and then confirmed and followed-up by transthoracic echocardiography (TTE). Consistency between both methods is important for follow-up. We sought to determine inter-technique reproducibility of the assessment of paravalvular AR after TAVI. METHODS AND RESULTS: The study included 165 patients treated with a self-expanding bioprosthesis and had angiography and TTE performed at a median interval of 4 days. TTE parameters of AR severity included VARC score (the average AR grade determined by the echocardiographic VARC-II criteria), pressure half time (PHT), regurgitation jet features in long-axis views (LAX score) and colour Doppler (CD) score (=paravalvular AR jet circumferential extent (%) + LAX score). Using receiver-operating characteristics curves, the cut-points that best defined an angiographic >mild AR were identified.On TTE, AR was paravalvular in all cases, multi-jet in 28%, and predominantly (64%) detected in the commissural region between the right and left coronary sinuses. Using VARC-II criteria (combining at least two), TTE agreed with angiographic classification in 53% of cases (k = 0.14). Greater than mild AR could better be defined by one of the following combinations of criteria: (i) LAX score >4.25 and VARC-II score >1.33; (ii) CD score >11.5 and PHT <400 ms. The combination of the CD score with PHT gave the best sum of sensitivity, specificity, positive, and negative predictive values. CONCLUSIONS: Agreement between angiography and TTE (using the VARC-II criteria) in the grading of post-TAVI AR is modest, and this might have contributed to the inconsistency of data on the rate and fate of paravalvular AR. Inter-technique reproducibility can be improved using a combination of CD and hemodynamic parameters. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Yosuke Miyazaki; Rodrigo Modolo; Mohammad Abdelghani; Hiroki Tateishi; Rafael Cavalcante; Carlos Collet; Taku Asano; Yuki Katagiri; Erhan Tenekecioglu; Rogério Sarmento-Leite; José A Mangione; Alexandre Abizaid; Osama I I Soliman; Yoshinobu Onuma; Patrick W Serruys; Pedro A Lemos; Fabio S de Brito Journal: Arq Bras Cardiol Date: 2018-08 Impact factor: 2.000