An objective and reproducible method for quantification of aortic regurgitation after TAVI.
OBJECTIVE
We describe a new semi-automated method that measures aortic regurgitation (AR) on contrast aortography with the objectives of reducing the inter-observer variability and standardising image acquisition.


RESULTS
Aortograms from three participating centres were reviewed to generate the following quality criteria: entire left ventricle and aortic root in view, descending aorta or TOE probe not over-projected, breath hold, no table motion, and adequate contrast opacification of the aortic root. AR was visually graded (Sellers) and was quantified by measuring the area under time-contrast density curves in the aortic root (reference) and the left ventricle. Quality criteria were met in 44 retrospectively identified aortograms and in 22 (69%) of 32 prospectively collected aortograms. The visual AR grade (Sellers) was highly correlated with time-density measurements including relative area under the curve (RAUC) and qRA index (r=0.81 and 0.83, respectively, p<0.001). Inter-observer reproducibility of visual grading was moderate (kappa 0.47-0.60, p<0.001). Inter-observer measurement of RAUC and qRA index were highly correlated (r=0.98, p<0.001) and showed a high level of agreement.


CONCLUSIONS
Quantification of aortic regurgitation by measurement of time-density changes on contrast aortography may improve the reproducibility of AR assessment in the catheter laboratory. Steps for standardised aortography acquisition are proposed.
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Carl J
CJ
Schultz
Tristan L B
TL
Slots
Gerald
G
Yong
Jean-Paul
JP
Aben
Nicolas
N
Van Mieghem
Martin
M
Swaans
Zouhair
Z
Rahhab
Nahid
N
El Faquir
Robert
R
van Geuns
Gijs
G
Mast
Felix
F
Zijlstra
Peter P T
PP
de Jaegere
D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D001027:Aortography / Q000379:methods*; D019540:Area Under Curve; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003287:Contrast Media; D005240:Feasibility Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D009426:Netherlands; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014904:Western Australia
D003287:Contrast Media