Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands.
CORRIB Research Centre for Advanced Imaging and Core Laboratory University of Galway Galway Ireland.
J Am Heart Assoc. 2024 Sep 17;13(18):e035587. doi: 10.1161/JAHA.124.035587. Epub 2024 Sep 13.
Paravalvular regurgitation (PVR) is a common complication after transcatheter aortic valve replacement, posing an increased risk of heart failure and mortality. Accurate intraprocedural quantification of PVR is challenging. Both hemodynamic indices and videodensitometry can be used for intraprocedural assessment of PVR. We compared the predictive value of the isolated versus combined use of the hemodynamic index diastolic delta (DD) and videodensitometry for the incidence of relevant PVR 1 month after transcatheter aortic valve replacement.
In this prospective cohort study, patients underwent periprocedural PVR assessment by DD and videodensitometry (using left ventricular outflow tract-aortic regurgitation [LVOT-AR]). Cardiac magnetic resonance served as reference modality for PVR assessment. Relevant PVR was defined as cardiac magnetic resonance-regurgitant fraction >20%. Fifty-one patients were enrolled in this study. Mean age was 80.6±5.2 years and 45.1% of patients were men. Mean LVOT-AR and cardiac magnetic resonance-regurgitant fraction were 8.2%±7.8% and 11.7%±9.6%, respectively. The correlation between DD and LVOT-AR was weak (=-0.36). DD and LVOT-AR showed a comparable accuracy to predict relevant PVR (area under the curve 0.82, 95% CI: 0.69-0.95 versus area area under the time-density curve 0.80, 95% CI: 0.62-0.99). The combination of DD and LVOT-AR improved the prediction of relevant PVR (area under the time-density curve, 0.90, 95% CI: 0.81-0.99), and resulted in an increased concordance (86.3%) and positive predictive value (75%) compared with DD alone (76.5% and 40%, respectively), or LVOT-AR alone (82.3% and 50%, respectively).
DD and videodensitometry are both accurate and feasible modalities for the assessment of PVR after transcatheter aortic valve replacement. The synergistic use of both techniques increases the predictive value for relevant PVR after transcatheter aortic valve replacement.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04281771.
经导管主动脉瓣置换术后并发瓣周漏（PVR）是一种常见并发症，增加了心力衰竭和死亡的风险。术中准确评估 PVR 具有挑战性。血流动力学指数和密度测定法均可用于术中评估 PVR。我们比较了血流动力学指数舒张期差值（DD）与密度测定法单独或联合使用对经导管主动脉瓣置换术后 1 个月时相关 PVR 发生率的预测价值。
在这项前瞻性队列研究中，患者通过 DD 和密度测定法（使用左心室流出道-主动脉瓣反流[LVOT-AR]）进行围手术期 PVR 评估。心脏磁共振作为 PVR 评估的参考方式。相关 PVR 的定义为心脏磁共振反流分数＞20%。本研究共纳入 51 例患者。平均年龄为 80.6±5.2 岁，45.1%的患者为男性。平均 LVOT-AR 和心脏磁共振反流分数分别为 8.2%±7.8%和 11.7%±9.6%。DD 与 LVOT-AR 相关性较弱（=-0.36）。DD 和 LVOT-AR 预测相关 PVR 的准确性相当（曲线下面积 0.82，95%CI：0.69-0.95 与时间密度曲线下面积 0.80，95%CI：0.62-0.99）。DD 和 LVOT-AR 联合可改善相关 PVR 的预测（时间密度曲线下面积为 0.90，95%CI：0.81-0.99），与 DD 单独（分别为 76.5%和 40%）或 LVOT-AR 单独（分别为 82.3%和 50%）相比，一致性（86.3%）和阳性预测值（75%）均提高。
DD 和密度测定法均是经导管主动脉瓣置换术后 PVR 评估的准确且可行的方法。两种技术的联合使用增加了经导管主动脉瓣置换术后相关 PVR 的预测价值。
