title: Evaluation of aortic regurgitation after transcatheter aortic valve implantation: aortic root angiography in comparison to cardiac magnetic resonance.
abstract: OBJECTIVE
  Aortic regurgitation (AR) is common after transcatheter aortic valve implantation (TAVI). Intraprocedural assessment of AR relies on aortic root angiography. Cardiac magnetic resonance (CMR) phase-contrast mapping of the ascending aorta provides accurate AR quantification. This study evaluated the accuracy of AR grading by aortic root angiography after TAVI in comparison to CMR phase-contrast velocity mapping.
  
  
  RESULTS
  In 69 patients with TAVI for severe aortic stenosis, post-procedural AR was determined by aortic root angiography with visual assessment according to the Sellers classification and by CMR using phase-contrast velocity mapping for analysis of AR volume and fraction. Spearman's correlation coefficient showed a moderate correlation between angiographic analysis of AR grade and CMR-derived AR volume (r=0.41; p<0.01) as well as AR fraction (r=0.42; p<0.01). There was significant overlap between the angiographic Sellers classes compared to CMR-derived AR fractions. Aortic root angiography with cut-off Sellers grade ≥2 had a sensitivity of 71% and a specificity of 98% to detect AR graded as moderate to severe or severe as defined by CMR.
  
  
  CONCLUSIONS
  There is only a moderate correlation between aortic root angiography and CMR in the classification of AR severity after TAVI. Alternative imaging including multimodality imaging as well as haemodynamic analysis should therefore be considered for intraprocedural AR assessment and guidance of TAVI procedure in cases of uncertainty in AR grading.
authors.affiliation: Medical Clinic I, University RWTH Aachen, Aachen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Frick
authors.forename: Christian G
authors.initials: CG
authors.lastname: Meyer
authors.forename: Annemarie
authors.initials: A
authors.lastname: Kirschfink
authors.forename: Ertunc
authors.initials: E
authors.lastname: Altiok
authors.forename: Michael
authors.initials: M
authors.lastname: Lehrke
authors.forename: Kathrin
authors.initials: K
authors.lastname: Brehmer
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfi
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome