Echocardiographic and angiographic assessment of paravalvular regurgitation after TAVI: optimizing inter-technique reproducibility

• Published in: European heart journal cardiovascular imaging 2016-08, Vol.17 (8), p.852-860
• Main Authors: Abdelghani, Mohammad, Tateishi, Hiroki, Spitzer, Ernest, Tijssen, Jan G, de Winter, Robbert J, Soliman, Osama I I, Hahn, Rebecca T, Serruys, Patrick W
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - therapy; Bioprosthesis; Cohort Studies; Computed Tomography Angiography - methods; Echocardiography, Doppler, Color - methods; Female; Follow-Up Studies; Humans; Image Interpretation, Computer-Assisted; Male; Observer Variation; Prosthesis Failure; Retreatment; Risk Assessment; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Statistics, Nonparametric; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jew083

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. 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