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Aortographic Assessment of Aortic Regurgitation After TAVR
Quick Takes
- Quantitative assessment of aortic regurgitation by aortography has been previously validated, but previous studies have been limited to core lab analysis.
- Real-time quantitative assessment of aortic regurgitation by aortography following TAVR is feasible and has high reproducibility with core lab analysis.
Study Questions:
What is the feasibility of assessment of aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) using real-time quantitative aortography?
Methods:
The OVAL (Online Videodensitometric Assessment of Aortic Regurgitation in the Cath-Lab) prospective, single-center study examined 100 consecutive patients undergoing TAVR and performed quantitative assessment of AR by aortography using a videodensitometry technique, which compares the time-density ratios between contrast regurgitated into the left ventricular outflow tract and contrast injected into the aortic root. One person was trained to measure AR real-time during the TAVR procedure, and the feasibility of measuring AR and the results were compared to offline core lab analysis.
Results:
Mean age of the 100 subjects was 81 ± 7 years and 44% were female. The online reviewer graded 92 (92%) studies as feasible, which was similar to the core lab findings (92%). Reproducibility between the real-time analysis and the core lab was high (r = 0.87, p < 0.001) with an intraclass coefficient of 0.96 (p < 0.001). There was no significant interobserver difference between real-time and core lab measurements of quantitative AR severity (6.5 ± 5.4% vs. 6.5 ± 6.0%). Severity of AR was graded as none/trace, mild, and moderate to severe in 50%, 45%, and 5% of cases, respectively.
Conclusions:
This study demonstrates that real-time quantitative assessment of AR by aortography following TAVR is feasible and has high reproducibility with core lab analysis.
Perspective:
With the declining use of transesophageal echocardiography during TAVR, accurate assessment of AR can be challenging. Transthoracic echocardiography can be technically difficult in patients who cannot be repositioned for optimal echo windows, and eccentric regurgitation can be underestimated. Quantitative assessment by aortography may represent a supplementary method to assess AR, although prior studies were performed by offline core lab analysis. This study finds that online real-time assessment during the TAVR procedure is highly feasible (92%) and was rapid (under 3 minutes), with no significant difference observed between real-time and core lab results. This study is limited by its small size, and its use of a single reader, a single site, and a single valve type. But these results suggest quantitative aortography could represent a new approach to real-time assessment of AR severity during TAVR and should prompt larger future studies that evaluate the role of this technique on patient outcomes and procedural success.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Aortic Valve Insufficiency, Aortography, Cardiac Surgical Procedures, Diagnostic Imaging, Echocardiography, Echocardiography, Transesophageal, Geriatrics, Heart Valve Diseases, Transcatheter Aortic Valve Replacement
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