title: Value of CMR in quantification of paravalvular aortic regurgitation after TAVI.
abstract: OBJECTIVE
  To assess the value of cardiac magnetic resonance (CMR) using phase-contrast velocity mapping for paravalvular aortic regurgitation (PAR) quantification.
  
  
  RESULTS
  All patients undergoing transcatheter aortic valve implantation (TAVI) in our centre between November 2012 and August 2013, without CMR-contraindication were included. PAR severity was assessed 5 days after TAVI using: transthoracic echocardiography (TTE) and CMR [regurgitant volume (RV), regurgitant fraction (RF)]. Aortic regurgitation (AR) index was obtained during TAVI. Thirty of 51 patients who underwent TAVI were included (COREVALVE, n = 10; or EDWARDS SAPIEN XT, n = 20). At TTE, PAR was mild in 22, moderate in 3, and severe in 5 patients. Reliable phase-contrast images were acquired at the sino-tubular junction for SAPIEN and at the tubular portion of the ascending aorta for COREVALVE. The reproducibility of CMR was high (coefficient of correlation = 0.99 for intra- and inter-operator variability). At CMR, RV, and RF were significantly (P < 0.0005) correlated with AR severity at TTE, with mean RF values at 9.2 ± 7.6% in mild, 20.3 ± 4.2% in moderate, and 46.8 ± 10.8% in severe PAR. A cut-off value of RF < 14% at CMR accurately discriminated mild from moderate/severe (sensitivity: 100%, specificity: 82%). The mean AR index was 29.4 ± 6 for mild and 13.8 ± 5 for moderate/severe PAR. Three patients had a RF > 14% and a low AR index <25 despite a mild PAR at TTE, suggesting an underestimation at TTE.
  
  
  CONCLUSIONS
  CMR is a reproducible, accurate, and reliable method to assess PAR severity. CMR may allow correcting an underestimation at TTE when AR index is doubtful.
authors.affiliation: Aix-Marseille Université, Marseille 13005, France Cardiology Department, AP-HM, La Timone Hospital, Boulevard Jeabn Moulin, Marseille 13005, France.
authors.forename: E
authors.initials: E
authors.lastname: Salaun
authors.affiliation: Radiology Department, AP-HM, La Timone Hospital, Marseille 13005, France.
authors.forename: A
authors.initials: A
authors.lastname: Jacquier
authors.affiliation: Cardiac Surgery Department, AP-HM, La Timone Hospital, Marseille 13005, France.
authors.forename: A
authors.initials: A
authors.lastname: Theron
authors.affiliation: Aix-Marseille Université, Marseille 13005, France.
authors.forename: R
authors.initials: R
authors.lastname: Giorgi
authors.affiliation: Cardiology Department, AP-HM, La Timone Hospital, Boulevard Jeabn Moulin, Marseille 13005, France.
authors.forename: M
authors.initials: M
authors.lastname: Lambert
authors.affiliation: Cardiac Surgery Department, AP-HM, La Timone Hospital, Marseille 13005, France.
authors.forename: N
authors.initials: N
authors.lastname: Jaussaud
authors.affiliation: Cardiology Department, AP-HM, La Timone Hospital, Boulevard Jeabn Moulin, Marseille 13005, France.
authors.forename: S
authors.initials: S
authors.lastname: Hubert
authors.affiliation: Cardiac Surgery Department, AP-HM, La Timone Hospital, Marseille 13005, France.
authors.forename: F
authors.initials: F
authors.lastname: Collart
authors.affiliation: Aix-Marseille Université, Marseille 13005, France Cardiology Department, AP-HM, La Timone Hospital, Boulevard Jeabn Moulin, Marseille 13005, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Bonnet
authors.affiliation: Aix-Marseille Université, Marseille 13005, France Cardiology Department, AP-HM, La Timone Hospital, Boulevard Jeabn Moulin, Marseille 13005, France gilbert.habib2@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Habib
authors.affiliation: Aix-Marseille Université, Marseille 13005, France Cardiology Department, AP-HM, La Timone Hospital, Boulevard Jeabn Moulin, Marseille 13005, France.
authors.forename: T
authors.initials: T
authors.lastname: Cuisset
authors.affiliation: Cardiac Surgery Department, AP-HM, La Timone Hospital, Marseille 13005, France.
authors.forename: D
authors.initials: D
authors.lastname: Grisoli
mesh_terms: D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000601:surgery*; D004452:Echocardiography / Q000379:methods; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D061330:Multidetector Computed Tomography / Q000379:methods; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods
keywords: aortic regurgitation; aortic stenosis; cardiovascular magnetic resonance; transcatheter aortic valve implantation