A Novel Angiographic Quantification of Aortic Regurgitation After TAVR Provides an Accurate Estimation of Regurgitation Fraction Derived From Cardiac Magnetic Resonance Imaging

OBJECTIVES: This study sought to compare a new quantitative angiographic technique to cardiac magnetic resonance-derived regurgitation fraction (CMR-RF) for the quantification of prosthetic valve regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). BACKGROUND: PVR after TAVR is challenging to quantify, especially during the procedure. METHODS: Post-replacement aortograms in 135 TAVR recipients were analyzed offline by videodensitometry to measure the ratio of the time-resolved contrast density in the left ventricular outflow tract to that in the aortic root (videodensitometric aortic regurgitation [VD-AR]). CMR was performed within an interval of =30 days (11 + - 6 days) after the procedure. RESULTS: The average CMR-RF was 6.7 + - 7.0% whereas the average VD-AR was 7.0 + - 7.0%. The correlation between VD-AR and CMR-RF was substantial (r = 0.78, p 0.001). On receiver-operating characteristic curves, a VD-AR =10% corresponded to mild PVR as defined by CMR-RF (area under the curve: 0.94; p 0.001; sensitivity 100%, specificity 83%), whereas a VD-AR =25% corresponded to moderate-to-severe PVR (area under the curve: 0.99; p = 0.004; sensitivity 100%, specificity 98%). Intraobserver reproducibility was excellent for both techniques (for CMR-RF, intraclass correlation coefficient: 0.91, p 0.001; for VD-AR intraclass correlation coefficient: 0.93, p 0.001). The difference on rerating was -0.04 + - 7.9% for CMR-RF and -0.40 + - 6.8% for VD-AR. CONCLUSIONS: The angiographic VD-AR provides a surrogate assessment of PVR severity after TAVR that correlates well with the CMR-RF.OBJECTIVES: This study sought to compare a new quantitative angiographic technique to cardiac magnetic resonance-derived regurgitation fraction (CMR-RF) for the quantification of prosthetic valve regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). BACKGROUND: PVR after TAVR is challenging to quantify, especially during the procedure. METHODS: Post-replacement aortograms in 135 TAVR recipients were analyzed offline by videodensitometry to measure the ratio of the time-resolved contrast density in the left ventricular outflow tract to that in the aortic root (videodensitometric aortic regurgitation [VD-AR]). CMR was performed within an interval of =30 days (11 + - 6 days) after the procedure. RESULTS: The average CMR-RF was 6.7 + - 7.0% whereas the average VD-AR was 7.0 + - 7.0%. The correlation between VD-AR and CMR-RF was substantial (r = 0.78, p 0.001). On receiver-operating characteristic curves, a VD-AR =10% corresponded to mild PVR as defined by CMR-RF (area under the curve: 0.94; p 0.001; sensitivity 100%, specificity 83%), whereas a VD-AR =25% corresponded to moderate-to-severe PVR (area under the curve: 0.99; p = 0.004; sensitivity 100%, specificity 98%). Intraobserver reproducibility was excellent for both techniques (for CMR-RF, intraclass correlation coefficient: 0.91, p 0.001; for VD-AR intraclass correlation coefficient: 0.93, p 0.001). The difference on rerating was -0.04 + - 7.9% for CMR-RF and -0.40 + - 6.8% for VD-AR. CONCLUSIONS: The angiographic VD-AR provides a surrogate assessment of PVR severity after TAVR that correlates well with the CMR-RF.