title: Aortic regurgitation after transcatheter aortic valve implantation (TAVI) - Angiographic, echocardiographic and hemodynamic assessment in relation to one year outcome.
abstract: BACKGROUND
  Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) remains a relatively frequent and life-limiting complication. However, the most prognostically discriminative (and therefore preferred) technique of AR evaluation after TAVI is not yet clearly defined. The aim of this study was to compare angiographic, echocardiographic and hemodynamic assessment of AR after TAVI in relation to one year outcome.
  
  
  RESULTS
  In this single center prospective cohort study, angiography (AR grading), echocardiography (AR quantification using color Doppler flow mapping) and invasive hemodynamics (AR index) were assessed before and after TAVI. All patients were followed up to at least one year. A total of 111 consecutive (very) high-risk patients with severe, symptomatic aortic valve stenosis underwent TAVI. No concordant relation could be demonstrated between angiographic, echocardiographic and invasive assessment of AR after TAVI. AR index <25 post TAVI was significantly influenced by left ventricular posterior wall thickness (odds ratio: 1.276, p=0.030) and AR index pre TAVI (odds ratio: 0.948, p=0.019). Neither angiographic nor hemodynamic AR assessments were able to discriminate between good or significantly decreased one year survival. In contrast, color Doppler flow mapping of AR after TAVI was highly reproducible, and able to differentiate between good or significantly decreased one year survival (AR grades 0-I: one year survival 87% vs. AR grades II-III-IV: one year survival 68%, p=0.035).
  
  
  CONCLUSIONS
  Echocardiography using color Doppler flow mapping is the preferred technique to assess prognostically relevant AR after TAVI.
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular diseases, Universiteitsplein 1, 2610 Antwerp, Belgium; Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, 2650 Edegem, Belgium. Electronic address: valerie.collas@uza.be.
authors.forename: Valérie M
authors.initials: VM
authors.lastname: Collas
authors.affiliation: Antwerp University Hospital, Department of Cardiac Surgery, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Paelinck
authors.affiliation: Antwerp University Hospital, Department of Cardiac Surgery, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Inez E
authors.initials: IE
authors.lastname: Rodrigus
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular diseases, Universiteitsplein 1, 2610 Antwerp, Belgium; Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Christiaan J
authors.initials: CJ
authors.lastname: Vrints
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular diseases, Universiteitsplein 1, 2610 Antwerp, Belgium; Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Johan M
authors.initials: JM
authors.lastname: Bosmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D018618:Echocardiography, Doppler, Color; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: Aortic regurgitation; Aortic valve stenosis; Paravalvular leakage; Transcatheter aortic valve implantation