Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
EuroIntervention. 2018 Jan 20;13(13):1527-1535. doi: 10.4244/EIJ-D-17-00595.
Videodensitometric assessment of aortography provides a periprocedural quantitation of prosthetic valve regurgitation (PVR) after transcatheter aortic valve implantation. We sought to compare the videodensitometric parameters of PVR severity to the regurgitation fraction (RF) in a controlled in vitro setting.
In a mock circulation system, a transcatheter balloon-expandable valve inserted at the aortic valve position was gradually deformed to induce different grades of paravalvular leakage and the RF was measured with a transonic flow probe. Contrast aortography was performed and the following videodensitometric parameters were generated: left ventricle aortic regurgitation (LV-AR), LV outflow tract AR (LVOT-AR), quantitative regurgitation assessment (qRA) index, relative maximum density (relative max), and maximum upslope of the LV time-density curve. The correlation was substantial between videodensitometric parameters (LV-AR, LVOT-AR, qRA index, relative max, and maximum upslope) and RF (r2=0.96, 0.96, 0.93, 0.87, and 0.93; p<0.001 for all). LV-AR (region of interest [ROI]=entire LV) and LVOT-AR (ROI=LVOT) were not different (p=0.51) and were strongly correlated (r2=0.99) with a mean difference of 1.92% (95% limits of agreement: ±2.83). The correlations of LV-AR and LVOT-AR with RF were stronger when more than one cardiac cycle was included in the analysis (one cycle: r2=0.85 and r2=0.83; four cycles: r2=0.96 and r2=0.96, for LV-AR and LVOT-AR, respectively). Including more cycles beyond four did not improve accuracy.
Quantitative assessment of PVR by videodensitometry of aortograms strongly correlates with the actual RF in a controlled in vitro setting. Accuracy is improved by including more than one cardiac cycle in the analysis.
经导管主动脉瓣植入术后，主动脉造影的视频密度评估可提供人工瓣膜反流（PVR）的术中定量评估。我们旨在比较视频密度参数评估的 PVR 严重程度与反流分数（RF）在对照的体外环境中的相关性。
在模拟循环系统中，将经导管球囊扩张瓣膜插入主动脉瓣位置，逐渐变形以诱导不同程度的瓣周漏，并使用跨声速流量探头测量 RF。进行对比主动脉造影，并生成以下视频密度参数：左心室主动脉瓣反流（LV-AR）、左心室流出道 AR（LVOT-AR）、定量反流评估（qRA）指数、相对最大密度（relative max）和左心室时间密度曲线最大斜率。视频密度参数（LV-AR、LVOT-AR、qRA 指数、relative max 和最大斜率）与 RF 之间具有显著相关性（r2=0.96、0.96、0.93、0.87 和 0.93；p<0.001）。LV-AR（感兴趣区 [ROI]=整个 LV）和 LVOT-AR（ROI=LVOT）无差异（p=0.51），且相关性较强（r2=0.99），平均差异为 1.92%（95%置信区间：±2.83）。当分析中包含多个心动周期时，LV-AR 和 LVOT-AR 与 RF 的相关性更强（一个周期：r2=0.85 和 r2=0.83；四个周期：r2=0.96 和 r2=0.96，分别用于 LV-AR 和 LVOT-AR）。包含超过四个心动周期并不能提高准确性。
在对照的体外环境中，主动脉造影的视频密度评估对 PVR 的定量评估与实际 RF 具有很强的相关性。通过在分析中包含多个心动周期可提高准确性。
