title: Echocardiographic and angiographic assessment of paravalvular regurgitation after TAVI: optimizing inter-technique reproducibility.
abstract: OBJECTIVE
  Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is often first diagnosed by angiography and then confirmed and followed-up by transthoracic echocardiography (TTE). Consistency between both methods is important for follow-up. We sought to determine inter-technique reproducibility of the assessment of paravalvular AR after TAVI.
  
  
  RESULTS
  The study included 165 patients treated with a self-expanding bioprosthesis and had angiography and TTE performed at a median interval of 4 days. TTE parameters of AR severity included VARC score (the average AR grade determined by the echocardiographic VARC-II criteria), pressure half time (PHT), regurgitation jet features in long-axis views (LAX score) and colour Doppler (CD) score (=paravalvular AR jet circumferential extent (%) + LAX score). Using receiver-operating characteristics curves, the cut-points that best defined an angiographic >mild AR were identified.On TTE, AR was paravalvular in all cases, multi-jet in 28%, and predominantly (64%) detected in the commissural region between the right and left coronary sinuses. Using VARC-II criteria (combining at least two), TTE agreed with angiographic classification in 53% of cases (k = 0.14). Greater than mild AR could better be defined by one of the following combinations of criteria: (i) LAX score >4.25 and VARC-II score >1.33; (ii) CD score >11.5 and PHT <400 ms. The combination of the CD score with PHT gave the best sum of sensitivity, specificity, positive, and negative predictive values.
  
  
  CONCLUSIONS
  Agreement between angiography and TTE (using the VARC-II criteria) in the grading of post-TAVI AR is modest, and this might have contributed to the inconsistency of data on the rate and fate of paravalvular AR. Inter-technique reproducibility can be improved using a combination of CD and hemodynamic parameters.
authors.affiliation: Academic Medical center, Amsterdam, The Netherlands.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdelghani
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tateishi
authors.affiliation: Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands.
authors.forename: Ernest
authors.initials: E
authors.lastname: Spitzer
authors.affiliation: Academic Medical center, Amsterdam, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Academic Medical center, Amsterdam, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands.
authors.forename: Osama I I
authors.initials: OI
authors.lastname: Soliman
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College London, London, UK patrick.w.j.c.serruys@gmail.com.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D001705:Bioprosthesis; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D015588:Observer Variation; D011475:Prosthesis Failure; D012372:ROC Curve; D019233:Retreatment; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: Angiography; Aortic regurgitation; Doppler echocardiography; Transcatheter aortic valve implantation