title: Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The aim of this study was to provide a simple, reproducible, and point-of-care assessment of peri-prosthetic aortic regurgitation (periAR) during transcatheter aortic valve implantation (TAVI) and to decipher the impact of this peri-procedural parameter on outcome.
  
  
  BACKGROUND
  Because periAR after TAVI might be associated with adverse outcome, precise quantification of periAR is of paramount importance but remains technically challenging.
  
  
  METHODS
  The severity of periAR was prospectively evaluated in 146 patients treated with the Medtronic CoreValve (Minneapolis, Minnesota) prosthesis by echocardiography, angiography, and measurement of the aortic regurgitation (AR) index, which is calculated as ratio of the gradient between diastolic blood pressure (DBP) and left ventricular end-diastolic pressure (LVEDP) to systolic blood pressure (SBP): [(DBP - LVEDP)/SBP] × 100.
  
  
  RESULTS
  After TAVI, 53 patients (36.3%) showed no signs of periAR and 71 patients (48.6%) showed only mild periAR, whereas 18 patients (12.3%) and 4 patients (2.7%) suffered from moderate and severe periAR, respectively. The AR index decreased stepwise from 31.7 ± 10.4 in patients without periAR, to 28.0 ± 8.5 with mild periAR, 19.6 ± 7.6 with moderate periAR, and 7.6 ± 2.6 with severe periAR (p < 0.001), respectively. Patients with AR index <25 had a significantly increased 1-year mortality risk compared with patients with AR index ≥25 (46.0% vs. 16.7%; p < 0.001). The AR index provided additional prognostic information beyond the echocardiographically assessed severity of periAR and independently predicted 1-year mortality (hazard ratio: 2.9, 95% confidence interval: 1.3 to 6.4; p = 0.009).
  
  
  CONCLUSIONS
  The assessment of the AR index allows a precise judgment of periAR, independently predicts 1-year mortality after TAVI, and provides additional prognostic information that is complementary to the echocardiographically assessed severity of periAR.
authors.affiliation: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud Strasse 25, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.forename: Viktoria
authors.initials: V
authors.lastname: Adenauer
authors.forename: Sisa Josefina
authors.initials: SJ
authors.lastname: Lema Cachiguango
authors.forename: Anne-Cathérine
authors.initials: AC
authors.lastname: Scheer
authors.forename: Sven
authors.initials: S
authors.lastname: Hausen
authors.forename: Alexander
authors.initials: A
authors.lastname: Sedaghat
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Cornelius
authors.initials: C
authors.lastname: Müller
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome