title: Angiographic assessment of aortic regurgitation by video-densitometry in the setting of TAVI: Echocardiographic and clinical correlates.
abstract: OBJECTIVE
  We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  AR after TAVI is common but challenging to quantitate, especially in the cath-lab.
  
  
  METHODS
  In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video-densitometric analysis of aortograms. Contrast time-density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT-AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region.
  
  
  RESULTS
  LVOT-AR was 0.10 ± 0.08, 0.13 ± 0.10 and 0.28 ± 0.14 in none-trace, mild and moderate-severe post-TAVI AR as defined by echocardiography (P < 0.001) and a cutpoint of >0.17 corresponded to moderate-severe AR on echocardiography (area under the curve = 0.84). At follow-up (median, 496 days), patients with LVOT-AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95-148] vs. 140 [112-169] g/m2, P = 0.009) and the prevalence of LV hypertrophy (LVH; 64 vs. 88%, P = 0.001) compared to baseline. In patients with LVOT-AR > 0.17, LVMi (149 [121-178] vs. 166 [144-188] g/m2, P = 0.14) and the prevalence of LVH (74 vs. 87%, P = 0.23) did not show a significant change. Compared to patients with LVOT-AR ≤ 0.17, those with LVOT-AR > 0.17 had an increased 30-day (16.4% vs. 7.1%, P = 0.035) and one year mortality (32.9 vs. 14.2%, log rank P value = 0.001; HR: 2.690 [1.461-4.953], P = 0.001).
  
  
  CONCLUSIONS
  LVOT-AR > 0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.|Cardiology Department, Al-Azhar University, Cairo, Egypt.
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: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cavalcante
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: OII
authors.lastname: Soliman
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: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.|Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Campos
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
authors.forename: Rogério S
authors.initials: RS
authors.lastname: Leite
authors.affiliation: Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
authors.forename: José A
authors.initials: JA
authors.lastname: Mangione
authors.affiliation: The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.|Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: de Brito
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D001027:Aortography / Q000379:methods*; D019540:Area Under Curve; D001938:Brazil; D003720:Densitometry; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: angiography; aortic stenosis; echocardiography; paravalvular regurgitation; transcatheter aortic valve implantation