Ye Dalin, Gao Ziqing, Ye Feile, Li Liujun, Chen Fei, Chen Xiaobo
Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Echocardiography. 2023 Oct;40(10):1040-1047. doi: 10.1111/echo.15669. Epub 2023 Aug 7.
The Valve Academic Research Consortium 3 (VARC-3) standardizes the classification criteria and Doppler parameters for paravalvular regurgitation (PVR) by echocardiography. However, the consistency between transesophageal echocardiography (TEE) and angiography in grading (using the VARC-3 criteria) of PVR during transcatheter aortic valve replacement (TAVR) is unclear.
Forty-six patients who underwent TEE and angiography during TAVR were retrospectively included. All patients had complete baseline information, TEE and angiography data. The Doppler parameters measured by TEE included the circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area. PVR was classified into four grades: absent, mild, moderate and severe. The weighted kappa coefficient was used to analyze the consistency between the two techniques. Kendall's W coefficient was used to evaluate the consistency of parameters measured by TEE.
Among all patients, there were 43 cases (93.5%) with consistent assessments between TEE and angiography. PVR was observed in 19 cases. TEE assessed mild PVR in 17 cases and moderate PVR in two cases; Angiography assessed mild PVR in 14 cases and moderate PVR in two cases. The weighted kappa coefficient between angiography and the circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area respectively was .84, .79, .74, .85 (P < .001). Kendall's W coefficient was .83 (P < .001).
TEE and angiography had strong consistency in the grading (using the VARC-3 criteria) of PVR during TAVR. TEE was a convenient diagnostic tool to quantify and grade PVR during TAVR.
瓣膜学术研究联盟3（VARC-3）对经超声心动图评估的瓣周反流（PVR）的分类标准和多普勒参数进行了标准化。然而，在经导管主动脉瓣置换术（TAVR）期间，经食管超声心动图（TEE）与血管造影在PVR分级（使用VARC-3标准）方面的一致性尚不清楚。
回顾性纳入46例在TAVR期间接受TEE和血管造影的患者。所有患者均有完整的基线信息、TEE和血管造影数据。TEE测量的多普勒参数包括PVR的圆周范围、反流容积、反流分数和有效反流口面积。PVR分为四级：无、轻度、中度和重度。采用加权kappa系数分析两种技术之间的一致性。采用Kendall's W系数评估TEE测量参数的一致性。
在所有患者中，43例（93.5%）TEE与血管造影的评估结果一致。观察到19例PVR。TEE评估为轻度PVR 17例，中度PVR 2例；血管造影评估为轻度PVR 14例，中度PVR 2例。血管造影与PVR圆周范围、反流容积、反流分数和有效反流口面积之间的加权kappa系数分别为0.84、0.79、0.74、0.85（P < 0.001）。Kendall's W系数为0.83（P < 0.001）。
在TAVR期间，TEE与血管造影在PVR分级（使用VARC-3标准）方面具有很强的一致性。TEE是TAVR期间量化和分级PVR的便捷诊断工具。
