BACKGROUND: Residual aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality; yet, determining AR severity post-TAVR using Doppler echocardiography remains challenging. Cardiovascular magnetic resonance (CMR) is purported as a more accurate means of quantifying AR; however, no data exist regarding the prognostic value of AR as assessed by CMR post-TAVR. OBJECTIVES: This study sought to evaluate the effect of AR assessed with CMR on clinical outcomes post-TAVR. METHODS: We included 135 patients from 3 centers. AR was quantified using regurgitant fraction (RF) measured by phase-contrast velocity mapping CMR at a median of 40 days post-TAVR, and using Doppler echocardiography at a median of 6 days post-TAVR. Median follow-up was 26 months. Clinical outcomes included mortality and rehospitalization for heart failure. RESULTS: Moderate-severe AR occurred in 17.1% and 12.8% of patients as measured by echocardiography and CMR, respectively. Higher RF post-TAVR was associated with increased mortality (hazard ratio: 1.18 for each 5% increase in RF [95% confidence interval: 1.08 to 1.30]; p < 0.001) and the combined endpoint of mortality and rehospitalization for heart failure (hazard ratio: 1.19 for each 5% increase in RF; 95% confidence interval: 1.15 to 1.23; p < 0.001). Prediction models yielded significant incremental predictive value; CMR performed a median of 40 days post-TAVR had a greater association with post-TAVR clinical events compared with early echocardiography (p < 0.01). RF ≥30% best predicted poorer clinical outcomes (p < 0.001 for either mortality or the combined endpoint of mortality and heart failure rehospitalization). CONCLUSIONS: Worse CMR-quantified AR was associated with increased mortality and poorer clinical outcomes following TAVR. Quantifying AR with CMR may identify patients with AR who could benefit from additional treatment measures.
BACKGROUND: Residual aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality; yet, determining AR severity post-TAVR using Doppler echocardiography remains challenging. Cardiovascular magnetic resonance (CMR) is purported as a more accurate means of quantifying AR; however, no data exist regarding the prognostic value of AR as assessed by CMR post-TAVR. OBJECTIVES: This study sought to evaluate the effect of AR assessed with CMR on clinical outcomes post-TAVR. METHODS: We included 135 patients from 3 centers. AR was quantified using regurgitant fraction (RF) measured by phase-contrast velocity mapping CMR at a median of 40 days post-TAVR, and using Doppler echocardiography at a median of 6 days post-TAVR. Median follow-up was 26 months. Clinical outcomes included mortality and rehospitalization for heart failure. RESULTS: Moderate-severe AR occurred in 17.1% and 12.8% of patients as measured by echocardiography and CMR, respectively. Higher RF post-TAVR was associated with increased mortality (hazard ratio: 1.18 for each 5% increase in RF [95% confidence interval: 1.08 to 1.30]; p < 0.001) and the combined endpoint of mortality and rehospitalization for heart failure (hazard ratio: 1.19 for each 5% increase in RF; 95% confidence interval: 1.15 to 1.23; p < 0.001). Prediction models yielded significant incremental predictive value; CMR performed a median of 40 days post-TAVR had a greater association with post-TAVR clinical events compared with early echocardiography (p < 0.01). RF ≥30% best predicted poorer clinical outcomes (p < 0.001 for either mortality or the combined endpoint of mortality and heart failure rehospitalization). CONCLUSIONS: Worse CMR-quantified AR was associated with increased mortality and poorer clinical outcomes following TAVR. Quantifying AR with CMR may identify patients with AR who could benefit from additional treatment measures.
Authors: Philippe Pibarot; Rebecca T Hahn; Neil J Weissman; Marie Arsenault; Jonathan Beaudoin; Mathieu Bernier; Abdellaziz Dahou; Omar K Khalique; Federico M Asch; Oumhani Toubal; Jonathon Leipsic; Philipp Blanke; Feifan Zhang; Rupa Parvataneni; Maria Alu; Howard Herrmann; Raj Makkar; Michael Mack; Richard Smalling; Martin Leon; Vinod H Thourani; Susheel Kodali Journal: JAMA Cardiol Date: 2017-11-01 Impact factor: 14.676
Authors: Marcel L Geleijnse; Luigi F M Di Martino; Wim B Vletter; Ben Ren; Tjebbe W Galema; Nicolas M Van Mieghem; Peter P T de Jaegere; Osama I I Soliman Journal: Cardiovasc Ultrasound Date: 2016-09-06 Impact factor: 2.062
Authors: Anthony A Bavry; Seyed H Aalaei-Andabili; Ashkan Karimi; Ki Park; Calvin Y Choi; Eddie W Manning; Thomas M Beaver; Wade W Stinson Journal: Cardiol Ther Date: 2017-06-30
Authors: Fernando L M Bernardi; Josep Rodés-Cabau; Gabriela Tirado-Conte; Ignacio J Amat Santos; Claudia Plachtzik; Fernando Cura; Matias Sztejfman; Fernanda M Mangione; Rogério Tumeleiro; Vinicius Borges Cardozo Esteves; Eduardo França Pessoa de Melo; Alejandro Alcocer Chauvet; Felipe Fuchs; Rogerio Sarmento-Leite; Estêvão Carvalho de Campos Martins; Luis Nombela-Franco; José Raul Delgado-Arana; Wolfgang Bocksch; Pablo Lamelas; Carlos Giuliani; Diego Carter Campanha-Borges; Jose A Mangione; Fábio Sandoli de Brito; Alexandre C Abizaid; Henrique B Ribeiro Journal: J Am Heart Assoc Date: 2021-09-03 Impact factor: 5.501
Authors: Michael B Hadley; Francesca Romana Prandi; Francesco Barillà; Samin Sharma; Annapoorna Kini; Stamatios Lerakis Journal: Front Cardiovasc Med Date: 2022-08-23