Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After Transcatheter Aortic Valve Replacement.

Abstract:

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.

journal_name

J Am Coll Cardiol

authors

Ribeiro HB,Orwat S,Hayek SS,Larose É,Babaliaros V,Dahou A,Le Ven F,Pasian S,Puri R,Abdul-Jawad Altisent O,Campelo-Parada F,Clavel MA,Pibarot P,Lerakis S,Baumgartner H,Rodés-Cabau J

doi

10.1016/j.jacc.2016.05.059

subject

Has Abstract

pub_date

2016-08-09 00:00:00

pages

577-585

issue

6

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(16)33403-9

journal_volume

68

pub_type

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