title: Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography.
abstract: OBJECTIVE
  The purpose of this study was to determine imaging predictors of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and the agreement and reproducibility of cardiovascular magnetic resonance (CMR), cardiac computed tomography (CCT), and transthoracic echocardiography (TTE) in aortic root assessment.
  
  
  BACKGROUND
  The optimal imaging strategy for planning TAVI is unclear with a paucity of comparative multimodality imaging data. The association between aortic root morphology and outcomes after TAVI also remains incompletely understood.
  
  
  METHODS
  A total of 202 consecutive patients assessed by CMR, CCT, and TTE for TAVI were studied. Agreement and variability among and within imaging modalities was assessed by Bland-Altman analysis. Postoperative AR was assessed by TTE.
  
  
  RESULTS
  Of the 202 patients undergoing TAVI assessment with both CMR and TTE, 133 also underwent CCT. Close agreement was observed between CMR and CCT in dimensions of the aortic annulus (bias, -0.4 mm; 95% limits of agreement: -5.7 to 5.0 mm), and similarly for sinus of Valsalva, sinotubular junction, and ascending aortic measures. Agreement between TTE-derived measures and either CMR or CCT was less precise. Intraobserver and interobserver variability were lowest with CMR. The presence and severity of AR after TAVI were associated with larger aortic valve annulus measurements by both CMR (p = 0.03) and CCT (p = 0.04) but not TTE-derived measures (p = 0.10). Neither CCT nor CMR measures of annulus eccentricity, however, predicted AR after TAVI (p = 0.33 and p = 0.78, respectively).
  
  
  CONCLUSIONS
  In patients undergoing imaging assessment for TAVI, the presence and severity of AR after TAVI were associated with larger aortic annulus measurements by both CMR and CCT, but not TTE. Both CMR and CCT provide highly reproducible information in the assessment of patients undergoing TAVI.
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jabbour
authors.forename: Tevfik F
authors.initials: TF
authors.lastname: Ismail
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
authors.forename: Ankur
authors.initials: A
authors.lastname: Gulati
authors.forename: Isabelle
authors.initials: I
authors.lastname: Roussin
authors.forename: Francisco
authors.initials: F
authors.lastname: Alpendurada
authors.forename: Bradley
authors.initials: B
authors.lastname: Park
authors.forename: Francois
authors.initials: F
authors.lastname: Okoroafor
authors.forename: Anita
authors.initials: A
authors.lastname: Asgar
authors.forename: Sarah
authors.initials: S
authors.lastname: Barker
authors.forename: Simon
authors.initials: S
authors.lastname: Davies
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: Michael
authors.initials: M
authors.lastname: Rubens
authors.forename: Raad H
authors.initials: RH
authors.lastname: Mohiaddin
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011184:Postoperative Period; D012372:ROC Curve; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome