Multimodality Imaging in Transcatheter Aortic Valve Implantation and Post-Procedural Aortic Regurgitation: Comparison Among Cardiovascular Magnetic Resonance, Cardiac Computed Tomography, and Echocardiography

OBJECTIVES: The purpose of this study was to determine imaging predictors of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and the agreement and reproducibility of cardiovascular magnetic resonance (CMR), cardiac computed tomography (CCT), and transthoracic echocardiography (TTE) in aortic root assessment. The optimal imaging strategy for planning TAVI is unclear with a paucity of comparative multimodality imaging data. The association between aortic root morphology and outcomes after TAVI also remains incompletely understood.

METHODS: A total of 202 consecutive patients assessed by CMR, CCT, and TTE for TAVI were studied. Agreement and variability among and within imaging modalities was assessed by Bland-Altman analysis. Postoperative AR was assessed by TTE.

RESULTS: Of the 202 patients undergoing TAVI assessment with both CMR and TTE, 133 also underwent CCT. Close agreement was observed between CMR and CCT in dimensions of the aortic annulus (bias, –0.4 mm; 95% limits of agreement: –5.7 to 5.0 mm), and similarly for sinus of Valsalva, sinotubular junction, and ascending aortic measures. Agreement between TTE-derived measures and either CMR or CCT was less precise. Intraobserver and interobserver variability were lowest with CMR. The presence and severity of AR after TAVI were associated with larger aortic valve annulus measurements by both CMR (p = 0.03) and CCT (p = 0.04) but not TTE-derived measures (p = 0.10). Neither CCT nor CMR measures of annulus eccentricity, however, predicted AR after TAVI (p = 0.33 and p = 0.78, respectively).

CONCLUSIONS: In patients undergoing imaging assessment for TAVI, the presence and severity of AR after TAVI were associated with larger aortic annulus measurements by both CMR and CCT, but not

TTE. Both CMR and CCT provide highly reproducible information in the assessment of patients undergoing TAVI.

PMID:

Schoenhagen Paul

Cardiovascular Imaging
Imaging Institute and
Heart&Vascular Institite
Cleveland Clinic
Cleveland, OH
Posted in Radiography and tagged , , , , .

2 Comments

  1. This is part of a FOCUS ISSUE: STRUCTURAL HEART DISEASE:

    TRANSCATHETER AORTIC VALVE IMPLANTATION:

    Stroke Associated With Surgical and Transcatheter Treatment of Aortic Stenosis: A Comprehensive Review
    Benoit Daneault, et al.
    J Am Coll Cardiol 2011 58: 2143-2150.

    Clinical Outcomes of Patients With Severe Aortic Stenosis at Increased Surgical Risk According to Treatment Modality
    Peter Wenaweser, et al.
    J Am Coll Cardiol 2011 58: 2151-2162.

    Multimodality Imaging in Transcatheter Aortic Valve Implantation and Post-Procedural Aortic Regurgitation: Comparison Among Cardiovascular Magnetic Resonance, Cardiac Computed Tomography, and Echocardiography
    Andrew Jabbour, et al.
    J Am Coll Cardiol 2011 58: 2165-2173.

    PERCUTANEOUS MITRAL VALVE INTERVENTIONS:

    The Evolution From Surgery to Percutaneous Mitral Valve Interventions: The Role of the Edge-to-Edge Technique
    Francesco Maisano, et al.
    J Am Coll Cardiol 2011 58: 2174-2182.

    Correction of Mitral Regurgitation in Nonresponders to Cardiac Resynchronization Therapy by MitraClip Improves Symptoms and Promotes Reverse Remodeling
    Angelo Auricchio, et al.
    J Am Coll Cardiol 2011 58: 2183-2189.

    Echocardiographic and Clinical Outcomes of MitraClip Therapy in Patients Not Amenable to Surgery
    Volker Rudolph, et al.
    J Am Coll Cardiol 2011 58: 2190-2195.

    PROSTHETIC VALVE FAILURE:

    Transcatheter Valve-in-Valve Implantation for Failed Surgical Bioprosthetic Valves
    Ronen Gurvitch, et al.
    J Am Coll Cardiol 2011 58: 2196-2209.

    Clinical Outcomes in Patients Undergoing Percutaneous Closure of Periprosthetic Paravalvular Leaks
    Carlos E. Ruiz, et al.
    J Am Coll Cardiol 2011 58: 2210-2217.

    Long-Term Follow-Up of Percutaneous Repair of Paravalvular Prosthetic Regurgitation
    Paul Sorajja, et al.
    J Am Coll Cardiol 2011 58: 2218-2224.

    STRUCTURAL DISEASE AND ATRIAL FIBRILLATION:

    Structural Abnormalities in Atrial Walls Are Associated With Presence and Persistency of Atrial Fibrillation But Not With Age
    Pyotr G. Platonov, et al.
    J Am Coll Cardiol 2011 58: 2225-2232.

    Transcatheter Patch Occlusion of the Left Atrial Appendage Using Surgical Adhesives in High-Risk Patients With Atrial Fibrillation
    Savvas Toumanides, et al.
    J Am Coll Cardiol 2011 58: 2236-2240.

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