Comparison of two- and three-dimensional transthoracic echocardiography to cardiac magnetic resonance imaging for assessment of paravalvular regurgitation after transcatheter aortic valve implantation.
This study evaluated 2-dimensional (2D) transthoracic echocardiography (TTE) using Valve Academic Research Consortium-2 (VARC-2) criteria and 3-dimensional (3D) TTE for assessment of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) in comparison with cardiac magnetic resonance (CMR) imaging. In 71 patients, 2D TTE, 3D TTE, and CMR imaging were performed to assess AR severity after TAVI. Using 2D TTE, AR severity was graded according to VARC-2 criteria and regurgitant volume (RVol) was determined. Three-dimensional color Doppler TTE allowed direct planimetry of the vena contracta area of the paravalvular regurgitation jet and calculation of the RVol as product with the velocity-time integral. RVol by CMR imaging was measured by phase-contrast velocity mapping in the ascending aorta. After TAVI, mean RVol determined by CMR imaging was 9.2 ± 9.6 ml/beat and mean regurgitant fraction was 13.3 ± 10.3%. AR was assessed as none or mild in 58 patients (82%) by CMR imaging. Correlation of 3D TTE and CMR imaging on RVol was better than correlation of 2D TTE and CMR imaging (r = 0.895 vs 0.558, p <0.001). There was good agreement between RVol by CMR imaging and by 3D TTE (mean bias = 2.4 ml/beat). Kappa on grading of AR severity was 0.357 between VARC-2 and CMR imaging versus 0.446 between 3D TTE and CMR imaging. Intraobserver variability for analysis of RVol of AR after TAVI was 73.5 ± 52.2% by 2D TTE, 16.7 ± 21.9% by 3D TTE, and 2.2 ± 2.0% by CMR imaging. In conclusion, 2D TTE considering VARC-2 criteria has limitations in the grading of AR severity after TAVI when CMR imaging is used for comparison. Three-dimensional TTE allows quantification of AR with greater accuracy than 2D TTE. Observer variability on RVol after TAVI is considerable using 2D TTE, significantly less using 3D TTE, and very low using CMR imaging.
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Ertunc
E
Altiok
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Michael
M
Frick
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Christian G
CG
Meyer
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Ghazi
G
Al Ateah
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Andreas
A
Napp
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Annemarie
A
Kirschfink
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Mohammad
M
Almalla
Department of Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Shahran
S
Lotfi
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Michael
M
Becker
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
Lena
L
Herich
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
Walter
W
Lehmacher
Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany. Electronic address: rhoffmann@ukaachen.de.
Rainer
R
Hoffmann
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume