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Rooijakkers, MJP, Stens, NA, Van Wely, MH, Van Der Wulp, K, Rodwell, L, Gehlmann, H, Van Garsse, LAFM, Geuzebroek, GSC, Verkroost, MWA, Habets, J, El Messaoudi, S, Thijssen, DHJ, Nijveldt, R and Van Royen, N (2023) Diastolic delta best predicts paravalvular regurgitation after transcatheter aortic valve replacement as assessed by cardiac magnetic resonance: the APPOSE trial. European Heart Journal Cardiovascular Imaging, 24 (8). pp. 1072-1081. ISSN 2047-2404
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Diastolic delta best predicts paravalvular regurgitation after transcatheter aortic valve replacement as assessed by cardiac magnetic resonance.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. Download (675kB) | Preview |
Abstract
Aims: 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. Methods and results: 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. Conclusion: 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Aortic Valve; Humans; Aortic Valve Insufficiency; Aortic Valve Stenosis; Treatment Outcome; Magnetic Resonance Spectroscopy; Severity of Illness Index; Prospective Studies; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement; aortic stenosis; cardiac magnetic resonance; outcomes; paravalvular regurgitation; transcatheter aortic valve replacement; Humans; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Heart Valve Prosthesis; Magnetic Resonance Spectroscopy; Prospective Studies; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome |
| Subjects: | R Medicine > RC Internal medicine |
| Divisions: | Sport & Exercise Sciences |
| Publisher: | Oxford University Press (OUP) |
| SWORD Depositor: | A Symplectic |
| Date Deposited: | 09 Apr 2024 14:46 |
| Last Modified: | 09 Apr 2024 14:46 |
| DOI or ID number: | 10.1093/ehjci/jead033 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/22995 |
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