title: Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography.
abstract: BACKGROUND
  We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR).
  
  
  RESULTS
  TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE.
  
  
  CONCLUSIONS
  Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Goncalves
authors.forename: Charles
authors.initials: C
authors.lastname: Nyman
authors.forename: David R
authors.initials: DR
authors.lastname: Okada
authors.forename: Avinainder
authors.initials: A
authors.lastname: Singh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Swanson
authors.forename: Michael
authors.initials: M
authors.lastname: Cheezum
authors.forename: Michael
authors.initials: M
authors.lastname: Steigner
authors.forename: Marcelo
authors.initials: M
authors.lastname: Di Carli
authors.forename: Scott
authors.initials: S
authors.lastname: Solomon
authors.forename: Pinak B
authors.initials: PB
authors.lastname: Shah
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Douglas
authors.initials: D
authors.lastname: Shook
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D001900:Boston; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019990:Perioperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000401:mortality*; D016896:Treatment Outcome