TY - JOUR
T1 - Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After Transcatheter Aortic Valve Replacement
AU - Ribeiro, Henrique B.
AU - Orwat, Stefan
AU - Hayek, Salim S.
AU - Larose, Éric
AU - Babaliaros, Vasilis
AU - Dahou, Abdellaziz
AU - Le Ven, Florent
AU - Pasian, Sergio
AU - Puri, Rishi
AU - Abdul-Jawad Altisent, Omar
AU - Campelo-Parada, Francisco
AU - Clavel, Marie Annick
AU - Pibarot, Philippe
AU - Lerakis, Stamatios
AU - Baumgartner, Helmut
AU - Rodés-Cabau, Josep
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/8/9
Y1 - 2016/8/9
N2 - 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.
AB - 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.
KW - aortic regurgitation
KW - aortic stenosis
KW - cardiovascular magnetic resonance imaging
KW - paravalvular leak
KW - transcatheter aortic valve implantation
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U2 - 10.1016/j.jacc.2016.05.059
DO - 10.1016/j.jacc.2016.05.059
M3 - Article
C2 - 27491900
AN - SCOPUS:84992046614
SN - 0735-1097
VL - 68
SP - 577
EP - 585
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -