title: A granular approach to improve reproducibility of the echocardiographic assessment of paravalvular regurgitation after TAVI.
abstract: Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is challenging to quantitate. Transthoracic echocardiography (TTE) is the main tool used for the assessment of PVL but is modestly reproducible. We sought to develop a reproducible echocardiographic approach to assess PVL in the post-TAVI setting. Four observers independently analyzed eleven parameters of PVL severity in 50 pre-discharge TTE studies performed after TAVI. The parameters included color-Doppler parameters [jet circumferential extent (CE) and planimetered vena contracta area in the short-axis view and jet breadth and qualitative features in the long-axis views], continuous-wave Doppler parameters [jet velocity time integral (VTI) and pressure half time (PHT)], quantitative Doppler parameters (regurgitation volume and fraction and effective regurgitant orifice area), aortic diastolic flow reversal and valve stent eccentricity. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) for numerical parameters and kappa coefficient (κ) for categorical parameters were calculated for inter- and intra-observer comparisons. Inter-observer ICC was highest and CV lowest for CE (0.88 and 0.36), jet origin breadth (0.82 and 0.39), jet qualitative features in long-axis views (0.87 and 0.26), jet VTI (0.87 and 0.04) and PHT (0.73 and 0.10). Similar results were found in intra-observer comparisons. A 2-step granular approach combining the most reproducible parameters was used to grade PVL by the four observers. Inter-observer agreement was achieved in 86 % of cases (κ = 0.79). Combining color Doppler and continuous wave Doppler parameters in a granular algorithm yields excellent reproducibility of PVL assessment by TTE.
authors.affiliation: Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdelghani
authors.affiliation: Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands.|Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Ren
authors.affiliation: Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands.
authors.forename: Ernest
authors.initials: E
authors.lastname: Spitzer
authors.affiliation: Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tateishi
authors.affiliation: Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Jonker
authors.affiliation: Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
authors.affiliation: Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: The International Centre for Circulatory Health, NHLI, Imperial College London, London, UK.
authors.forename: Patrick W J C
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, 3012KM, The Netherlands. o.soliman@erasmusmc.nl.|Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands. o.soliman@erasmusmc.nl.
authors.forename: Osama I I
authors.identifier: http://orcid.org/0000-0003-0758-3539
authors.initials: OI
authors.lastname: Soliman
mesh_terms: D000465:Algorithms; 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*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Aortic-valves; Echocardiography; Imaging; Regurgitation