Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
Department of Physiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2023 Jul 24;24(8):1072-1081. doi: 10.1093/ehjci/jead033.
Paravalvular regurgitation (PVR) is a common complication after transcatheter aortic valve replacement (TAVR) that poses an increased risk of rehospitalization for heart failure and mortality. The aim of this study was to assess the accuracy of haemodynamic indices to predict relevant PVR.
In this prospective single-centre clinical trial, four haemodynamic indices of PVR measured during TAVR were assessed for their correlation with gold standard cardiac magnetic resonance (CMR)-derived regurgitant fraction (CMR-RF) at 1 month follow-up: diastolic delta (DD), heart rate-adjusted diastolic delta (HR-DD), aortic regurgitation index (ARI), and aortic regurgitation index ratio (ARI ratio). These haemodynamic indices were analysed for their ability to predict relevant PVR (defined as CMR-RF > 20%) using receiver operating characteristic (ROC) curves with corresponding area under the ROC curves (AUCs). A total of 77 patients were included and had CMR performed 41 ± 14 days after TAVR. Mean CMR-RF was 12.4 ± 9.3%. Fifteen (19.5%) patients had CMR-RF > 20%. DD had the best correlation with CMR-RF and the highest AUC to predict relevant PVR (0.82; 95% CI, 0.72-0.92), followed by HR-DD (AUC 0.78; 95% CI, 0.67-0.89), ARI (AUC 0.78; 95% CI, 0.66-0.89), and ARI ratio (AUC 0.65; 95% CI, 0.49-0.81). The optimal cut-off value for DD was 32 mmHg, with sensitivity of 69% and specificity of 77% in predicting relevant PVR.
DD measured during TAVR best predicts relevant PVR. Correction for heart rate (HR-DD) or systolic blood pressure (ARI, ARI ratio) did not improve this predictive value.
瓣周漏（PVR）是经导管主动脉瓣置换术（TAVR）后的常见并发症，会增加因心力衰竭和死亡而再住院的风险。本研究旨在评估血流动力学指标预测相关 PVR 的准确性。
在这项前瞻性单中心临床试验中，评估了 TAVR 期间测量的四个 PVR 血流动力学指标与 1 个月随访时心脏磁共振（CMR）衍生反流分数（CMR-RF）的相关性：舒张期差值（DD）、心率校正的舒张期差值（HR-DD）、主动脉瓣反流指数（ARI）和主动脉瓣反流指数比（ARI 比）。使用受试者工作特征（ROC）曲线及其相应的 ROC 曲线下面积（AUC），分析这些血流动力学指标预测相关 PVR（定义为 CMR-RF > 20%）的能力。共纳入 77 例患者，TAVR 后 41 ± 14 天进行 CMR。平均 CMR-RF 为 12.4 ± 9.3%。15 例（19.5%）患者的 CMR-RF > 20%。DD 与 CMR-RF 相关性最好，预测相关 PVR 的 AUC 最高（0.82；95%CI，0.72-0.92），其次是 HR-DD（AUC 0.78；95%CI，0.67-0.89）、ARI（AUC 0.78；95%CI，0.66-0.89）和 ARI 比（AUC 0.65；95%CI，0.49-0.81）。DD 的最佳截断值为 32mmHg，预测相关 PVR 的敏感性为 69%，特异性为 77%。
TAVR 期间测量的 DD 最能预测相关 PVR。校正心率（HR-DD）或收缩压（ARI、ARI 比）并未提高这种预测价值。
