title: Heart-rate adjustment of transcatheter haemodynamics improves the prognostic evaluation of paravalvular regurgitation after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Paravalvular aortic regurgitation (PVAR) after balloon-expandable transcatheter aortic valve implantation (TAVI) remains difficult to quantify, and the utility of the AR index (ARi) to create a composite aortic insufficiency (CAI) score was an important advance. Heart rate (HR) influences the ARi but the clinical relevance of this phenomenon remains poorly appreciated. We sought to validate a new composite heart-rate-adjusted haemodynamic-echocardiographic aortic insufficiency (CHAI) score in the prognostic evaluation of PVAR after balloon-expandable TAVI.
  
  
  RESULTS
  The severity of PVAR was assessed immediately post TAVI by transoesophageal echocardiography (TOE) with simultaneous assessment of transcatheter haemodynamics. A total of 303 patients were studied. The CHAI score, incorporating the HR-adjusted diastolic-delta (HRA-DD, the difference between left ventricular and aortic diastolic pressures/HR*80), had a greater discriminatory value for one-year mortality than both PVAR by TOE (p=0.0018) and the previously proposed CAI score, based on the ARi without HR adjustment (p=0.0029). The CHAI score also better stratified percentage increases in left ventricular systolic chamber dimensions at one month and serum natriuretic peptide levels at one to three months.
  
  
  CONCLUSIONS
  Prognostication of PVAR in the intermediate range of echocardiographic severity remains unreliable and is greatly enhanced by the integration of heart-rate-adjusted transcatheter haemodynamics.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
authors.forename: Asim
authors.initials: A
authors.lastname: Rafique
authors.forename: Kenji
authors.initials: K
authors.lastname: Harada
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shibayama
authors.forename: Niraj
authors.initials: N
authors.lastname: Doctor
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Tejas
authors.initials: T
authors.lastname: Rami
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Okuyama
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Omar
authors.initials: O
authors.lastname: Sadruddin
authors.forename: Robert
authors.initials: R
authors.lastname: Siegel
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D062186:Arterial Pressure; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D062906:Cardiac Catheters; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006339:Heart Rate; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D017725:Ventricular Pressure