title: Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After Transcatheter Aortic Valve Replacement.
abstract: Residual aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality; yet, determining AR severity post-TAVR using Doppler echocardiography remains challenging. Cardiovascular magnetic resonance (CMR) is purported as a more accurate means of quantifying AR; however, no data exist regarding the prognostic value of AR as assessed by CMR post-TAVR.
  
  
  
  This study sought to evaluate the effect of AR assessed with CMR on clinical outcomes post-TAVR.
  
  
  
  We included 135 patients from 3 centers. AR was quantified using regurgitant fraction (RF) measured by phase-contrast velocity mapping CMR at a median of 40 days post-TAVR, and using Doppler echocardiography at a median of 6 days post-TAVR. Median follow-up was 26 months. Clinical outcomes included mortality and rehospitalization for heart failure.
  
  
  
  Moderate-severe AR occurred in 17.1% and 12.8% of patients as measured by echocardiography and CMR, respectively. Higher RF post-TAVR was associated with increased mortality (hazard ratio: 1.18 for each 5% increase in RF [95% confidence interval: 1.08 to 1.30]; p < 0.001) and the combined endpoint of mortality and rehospitalization for heart failure (hazard ratio: 1.19 for each 5% increase in RF; 95% confidence interval: 1.15 to 1.23; p < 0.001). Prediction models yielded significant incremental predictive value; CMR performed a median of 40 days post-TAVR had a greater association with post-TAVR clinical events compared with early echocardiography (p < 0.01). RF ≥30% best predicted poorer clinical outcomes (p < 0.001 for either mortality or the combined endpoint of mortality and heart failure rehospitalization).
  
  
  
  Worse CMR-quantified AR was associated with increased mortality and poorer clinical outcomes following TAVR. Quantifying AR with CMR may identify patients with AR who could benefit from additional treatment measures.
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Henrique B
authors: HB
authors: Ribeiro
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Stefan
authors: S
authors: Orwat
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Salim S
authors: SS
authors: Hayek
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Éric
authors: É
authors: Larose
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Vasilis
authors: V
authors: Babaliaros
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Abdellaziz
authors: A
authors: Dahou
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Florent
authors: F
authors: Le Ven
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Sergio
authors: S
authors: Pasian
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Rishi
authors: R
authors: Puri
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Omar
authors: O
authors: Abdul-Jawad Altisent
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Francisco
authors: F
authors: Campelo-Parada
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Marie-Annick
authors: MA
authors: Clavel
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Stamatios
authors: S
authors: Lerakis
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Helmut
authors: H
authors: Baumgartner
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: aortic regurgitation; aortic stenosis; cardiovascular magnetic resonance imaging; paravalvular leak; transcatheter aortic valve implantation