title: Aortic regurgitation severity after transcatheter aortic valve implantation is underestimated by echocardiography compared with MRI.
abstract: OBJECTIVE
  Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is associated with a poor clinical outcome and its assessment therefore crucial. Quantification of AR by transthoracic echocardiography (TTE), however, remains challenging in this setting. The present study used quantitative flow measurement by cardiac MRI (CMR) with calculation of regurgitant fraction (RF) for the assessment of AR and compared the results with TTE.
  
  
  RESULTS
  We included 65 patients with a mean age of 82.2±8.1 years (38 women) who underwent successful TAVI with Edwards SAPIEN valves (52 transfemoral, 13 transapical). The post-interventional degree of AR was assessed by CMR and by TTE. There was agreement between CMR and TTE with regards to the absence of severe AR. However, TTE significantly underestimated the presence of moderate AR classifying it to be mild in 38 and moderate in only 5 patients, whereas CMR found mild AR in 23 and moderate in 16 patients. Overall, there was only fair agreement between CMR and TTE regarding the grading of AR with a weighted κ of 0.33. The rate of detection of TTE for more than mild AR was only 19%.
  
  
  CONCLUSIONS
  Using CMR for the quantification of AR in a sizeable group of TAVI patients, we demonstrate a strong tendency of TTE to underestimate AR compared with CMR. Since higher AR severity on echocardiography has been associated with worse patient outcome, the potential incremental prognostic value of CMR should be studied prospectively in this setting.
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Stefan
authors: S
authors: Orwat
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Gerhard-Paul
authors: GP
authors: Diller
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Gerrit
authors: G
authors: Kaleschke
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Gregor
authors: G
authors: Kerckhoff
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Aleksander
authors: A
authors: Kempny
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Robert M
authors: RM
authors: Radke
authors: Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.
authors: Boris
authors: B
authors: Buerke
authors: Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.
authors: Matthias
authors: M
authors: Burg
authors: Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.
authors: Christoph
authors: C
authors: Schülke
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Helmut
authors: H
authors: Baumgartner
mesh_terms: D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*