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Proffitt EK, Kaproth-Joslin K, Chaturvedi A, Hobbs SK. Role of Magnetic Resonance Imaging in Transcatheter Structural Heart Disease Interventions. Semin Roentgenol 2024; 59:20-31. [PMID: 38388093 DOI: 10.1053/j.ro.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, Division of Cardiothoracic Imaging, University of Rochester Medical Center, Rochester, NY.
| | - Susan K Hobbs
- University of Rochester Medical Center, Rochester, NY
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Dweck MR, Loganath K, Bing R, Treibel TA, McCann GP, Newby DE, Leipsic J, Fraccaro C, Paolisso P, Cosyns B, Habib G, Cavalcante J, Donal E, Lancellotti P, Clavel MA, Otto CM, Pibarot P. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur Heart J Cardiovasc Imaging 2023; 24:1430-1443. [PMID: 37395329 DOI: 10.1093/ehjci/jead153] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
In this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk stratification, and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aortic stenosis providing detailed assessments of valve haemodynamics and the cardiac remodelling response. Computed tomography (CT) is already widely used in the planning of transcutaneous aortic valve implantation. We anticipate its increased use as an anatomical adjudicator to clarify disease severity in patients with discordant echocardiographic measurements. CT calcium scoring is currently used for this purpose; however, contrast CT techniques are emerging that allow identification of both calcific and fibrotic valve thickening. Additionally, improved assessments of myocardial decompensation with echocardiography, cardiac magnetic resonance, and CT will become more commonplace in our routine assessment of aortic stenosis. Underpinning all of this will be widespread application of artificial intelligence. In combination, we believe this new era of multi-modality imaging in aortic stenosis will improve the diagnosis, follow-up, and timing of intervention in aortic stenosis as well as potentially accelerate the development of the novel pharmacological treatments required for this disease.
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Affiliation(s)
- Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Krithika Loganath
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Thomas A Treibel
- Barts Heart Centre, Bart's Health NHS Trust, W Smithfield, EC1A 7BE, London, UK
- University College London Institute of Cardiovascular Science, 62 Huntley St, WC1E 6DD, London, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicester LE1 7RH, UK
- The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, 1081 Burrard St Room 166, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science and Public Health, Via Giustiniani, 2 - 35128, Padua, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80125 Naples, Italy
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - João Cavalcante
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| | - Erwan Donal
- Cardiology and CIC, Université Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes, France
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Corso Giuseppe Garibaldi, 11, 48022 Lugo RA, Italy
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
- Faculté de Médecine-Département de Médecine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 4333 Brooklyn Ave NE Box 359458, Seattle, WA 98195-9458, USA
| | - Phillipe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
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Pykäri J, Vasankari T, Ylitalo A, Porela P, Paana T, Malmberg M, Laurila S, Koskinen J, Koivisto T, Savontaus M. Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR. Cardiol Ther 2023; 12:361-369. [PMID: 36899283 DOI: 10.1007/s40119-023-00307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL). METHODS Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation. RESULTS A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups. CONCLUSION A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure.
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Affiliation(s)
- Jouni Pykäri
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Tuija Vasankari
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Antti Ylitalo
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Pekka Porela
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Tuomas Paana
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Markus Malmberg
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Sanna Laurila
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland.,Satakunta Central Hospital, Sairalantie 3, Pori, Finland
| | - Juho Koskinen
- Department of Future Technologies, University of Turku, 20014, Turku, Finland
| | - Tero Koivisto
- Department of Future Technologies, University of Turku, 20014, Turku, Finland
| | - Mikko Savontaus
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland.
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Edris A, Manla Y, Al Badarin F, Hasan K, Hashmani S, Traina M, Khiati D, Khalouf A, El Zouhbi A, Tuzcu EM. Outcomes of Transcatheter Aortic Valve Replacement in the United Arab Emirates: Real-world, Single-centre Experience from an Emerging Programme. Interv Cardiol 2023; 18:e08. [PMID: 37601733 PMCID: PMC10433106 DOI: 10.15420/icr.2022.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/01/2022] [Indexed: 03/15/2023] Open
Abstract
Background Data on outcomes of transcatheter aortic valve replacement (TAVR) in the Middle East, particularly in the United Arab Emirates (UAE), are limited. Whether centres with a low volume of patients requiring the procedure can achieve similar outcomes as those reported in pivotal clinical trials remains unclear. This study evaluates procedural outcomes of patients undergoing TAVR in a newly established programme in the UAE. Methods Procedural outcomes of consecutive patients who underwent transfemoral TAVR at a single centre in the UAE between January 2016 and November 2021 were compared with those at centres in the lowest quartile (Q1) of procedural volume in the Transcatheter Valve Therapy Registry, which covers centres in the US. Results Among the 183 patients included in the study, the median age was 76 years (interquartile range [IQR] 71-82), and 42.1% of patients were women, with a median Society of Thoracic Surgeons predicted risk of mortality score of 4.6 (IQR 2.9-7.5). Most of the patients (93.3%) received a balloon-expandable valve. All-cause death within 30 days, stroke and major vascular complications occurred in 0.6%, 0.6% and 2.2% of patients, respectively, compared with 3.1%, 2.2% and 4% in patients treated at Q1 hospitals. Conclusion Patients undergoing transfemoral TAVR at an emerging centre in the Middle East had favourable outcomes compared with those performed at Q1 hospitals in the US. These findings suggest that careful patient selection for TAVR is critical and may help optimise patient outcomes, especially when procedural volumes are low.
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Affiliation(s)
- Ahmad Edris
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Yosef Manla
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Firas Al Badarin
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Khwaja Hasan
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Shahrukh Hashmani
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Mahmoud Traina
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Dhiaedin Khiati
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Amani Khalouf
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Anas El Zouhbi
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Emin Murat Tuzcu
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
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Schoechlin S, Hein M, Brennemann T, Eichenlaub M, Schulz U, Jander N, Neumann F. 5‐Year outcomes after transcatheter aortic valve implantation: Focus on paravalvular leakage assessed by echocardiography and hemodynamic parameters. Catheter Cardiovasc Interv 2022; 99:1582-1589. [DOI: 10.1002/ccd.30083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/05/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Simon Schoechlin
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
| | - Manuel Hein
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
| | - Tim Brennemann
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
| | - Undine Schulz
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
| | - Nikolaus Jander
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
| | - Franz‐Josef Neumann
- Department of Cardiology and Angiology II University Heart Center Freiburg‐Bad Krozingen Bad Krozingen Germany
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Parikh PB, Romeiser JL, Dhautel B, Mitchell D, Holecek W, Bilfinger T, Poppers J, Bennett-Guerrero E. Predictors and impact of low diastolic blood pressure and widened pulse pressure following transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:20-25. [PMID: 34764032 DOI: 10.1016/j.carrev.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR. METHODS The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality. RESULTS Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04]. CONCLUSIONS In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
| | - Jamie L Romeiser
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Britney Dhautel
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Duran Mitchell
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - William Holecek
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Jeremy Poppers
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Elliott Bennett-Guerrero
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
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Kitamura M, Von Roeder M, Abdel-Wahab M. Quantitative assessment of aortic regurgitation following transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:633-645. [PMID: 33945360 DOI: 10.1080/14779072.2021.1924675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is expanding to lower risk and younger patients with severe symptomatic aortic valve disease. Despite clinical and technological improvements, post-procedural aortic regurgitation (AR) remains a limitation of TAVR, particularly when compared to surgical aortic valve replacement. Although several methods for AR quantification after TAVR are currently available, its exact graduation in everyday clinical practice remains challenging.Areas covered: This review describes the currently available evaluation methods of AR after TAVR, with a special emphasis on the quantitative assessment using videodensitometric angiography, echocardiography and cardiac magnetic resonance imaging.Expert opinion: In the majority of clinical scenarios, satisfactory evaluation of post-TAVR AR can be achieved with a combination of post-procedural angiography, hemodynamic indices and transthoracic echocardiography. Nevertheless, some TAVR patients show 'intermediate' forms of post-procedural AR, in which quantitative evaluation is mandatory for prognostic purposes and further decision-making. Notably, interpretation of quantitative measures early post-TAVR is challenging because of the lack of left ventricular enlargement. Video-densitometric angiography is an emerging method that appears to be clinically attractive for immediate post-TAVR assessment, but requires further validation in everyday clinical practice.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian Von Roeder
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Hemodynamic performance of the balloon-expandable SAPIEN 3 valve as assessed by cardiac magnetic resonance. Int J Cardiol 2020; 320:128-132. [PMID: 32702409 DOI: 10.1016/j.ijcard.2020.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/13/2020] [Accepted: 07/16/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Scarce data exist on transcatheter heart valve (THV) performance evaluated by cardiac magnetic resonance (CMR) in newer generation THV patients. Furthermore, it has been suggested that echocardiographic evaluation after TAVR may inaccurately assess residual AR in some patients. This study aimed to determine the incidence and severity of aortic regurgitation (AR) assessed by CMR in patients undergoing TAVR with the SAPIEN 3 valve, and evaluate the agreement between CMR and transthoracic echocardiography (TTE) on the assessment of AR severity in such patients. METHODS This multicentric observational study included 146 SAPIEN 3 patients with TTE and CMR within the month following their procedure. According to the CMR regurgitation fraction (RF), AR was considered mild and moderate-severe if the RF was 15-<30% and ≥ 30%, respectively. TTE exams followed VARC-2 recommendations. RESULTS By CMR, SAPIEN 3 recipients displayed a mean RF of 5.0 ± 6.1%, and mild and moderate-severe AR rates of 3.4% and 0.7%, respectively. The agreement between CMR-TTE was modest (weighted κ = 0.2640, p<0.001), due to an overestimation of AR severity by TTE. A historical cohort of 139 SAPIEN XT patients with a post-procedure CMR, displayed a mean RF of 9.6 ± 10.7% and mild and moderate-severe AR rates of 18.7% and 3.6%, respectively (p < .001 vs. SAPIEN 3 group). CONCLUSIONS SAPIEN 3 recipients exhibited very low rates of residual AR by CMR, suggesting a surgical-like performance regarding AR with this newer generation THV. TTE tended to overestimate the severity of AR, particularly among mild AR patients.
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Mahon C, Mohiaddin RH. The emerging applications of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation. Clin Radiol 2019; 76:73.e21-73.e37. [PMID: 31879023 DOI: 10.1016/j.crad.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in selected patients with severe symptomatic aortic stenosis (AS) and high surgical risk. The planning and follow-up of TAVI requires an array of imaging techniques, each has advantages and limitations. Echocardiography and multidetector computer tomography (MDCT) have established applications in patient selection and procedure guidance, but are limited in some patients. TAVI applications of cardiovascular magnetic resonance imaging (CMRI) are emerging. CMRI can provide the structural and functional imaging details required for TAVI procedure in away comparable or superior to that obtained by echocardiography and MDCT combined. In this review, we look at the continuously evolving role of CMRI as a complimentary or an alternative to more established imaging techniques and address the advantages and disadvantages of CMRI in this setting. We discuss the role of CMRI in selecting anatomically suitable patients for the TAVI procedure and in the post-TAVI follow-up with particular emphasis on its applications for assessing AS severity and haemodynamic impact, vascular imaging for TAVI access route, quantification of paravalvular leaks and LV remodelling in the post TAVI setting as well as providing imaging biomarkers tool for AS risk-stratification.
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Affiliation(s)
- C Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - R H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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Papanastasiou CA, Kokkinidis DG, Jonnalagadda AK, Oikonomou EK, Kampaktsis PN, Garcia MJ, Myerson SG, Karamitsos TD. Meta-Analysis of Transthoracic Echocardiography Versus Cardiac Magnetic Resonance for the Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:1246-1251. [PMID: 31466694 DOI: 10.1016/j.amjcard.2019.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
Abstract
Residual aortic regurgitation (AR) is a major complication after transcatheter aortic valve implantation (TAVI). Although the echocardiographic assessment of post-TAVI AR remains challenging, cardiac magnetic resonance (CMR) allows direct quantification of AR. The aim of this study was to review the level of agreement between 2-dimensional transthoracic echocardiography (2D TTE) and CMR on grading the severity of AR after TAVI, and determine the accuracy of TTE in detecting moderate or severe AR. Electronic databases were searched in order to identify studies comparing 2D TTE to CMR for post-TAVI AR assessment. Kappa coefficient was used to determine the level of agreement between the 2 imaging modalities. CMR was used as the reference standard in order to assess the diagnostic accuracy of 2D TTE. Seven studies were included in this systematic review. Six studies reported a low correlation between 2D TTE and CMR (kappa coefficient ranging from -0.02 to 0.41), whereas one study showed good agreement with a kappa coefficient of 0.72. Given the heterogeneity in the included studies the diagnostic accuracy of TTE was evaluated by estimating the hierarchical summary receiver operator characteristic curve. The area under the curve for detection of moderate or severe AR with TTE was 0.83 (95% confidence interval 0.79 to 0.86). In conclusion, despite the reported significant disconcordance between TTE and CMR grading of AR, TTE has sufficient ability to discriminate moderate or severe AR from mild or none AR after TAVI in the clinical setting. CMR should be considered when TTE results are equivocal.
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Affiliation(s)
- Christos A Papanastasiou
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Anil K Jonnalagadda
- Division of Cardiology, Medstar, Washington Hospital Center, Washington, District of Columbia
| | - Evangelos K Oikonomou
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Polydoros N Kampaktsis
- Department of Medicine, New York Presbyterian Hospital/Weil Cornell Medical College, New York
| | - Mario J Garcia
- Division of Cardiology, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Theodoros D Karamitsos
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
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Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour YM, Krishnaswamy A, Jaber WA, Mick S, Svensson LG, Kapadia SR. Time-Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival. J Am Heart Assoc 2019; 8:e012430. [PMID: 31269863 PMCID: PMC6662132 DOI: 10.1161/jaha.119.012430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Balloon postdilation (BPD) has emerged as an effective strategy to reduce paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR). We investigated the utility of a time‐integrated aortic regurgitation index (TIARI) to guide balloon postdilation (BPD) after valve deployment. Methods and Results All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during TAVR were included in the study. Catheter‐derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent TAVR, 49 (32%) patients required BPD to reduce significant PVR after valve deployment. Two experienced operators decided whether the patients required BPD for significant PVR. Median TIARI measured immediately after valve deployment was significantly lower in patients who required BPD when compared with patients who did not require BPD (P<0.001). In a multivariable analysis, lower TIARI (odds ratio: 0.81; P=0.003) and higher PVR grade on aortography and echocardiography (P<0.001 for both) were associated with BPD. Adding TIARI to echocardiography and aortographic PVR assessment resulted in a significant increase in global χ2 (P<0.001), an integrated discrimination index of 9% (P=0.002), and combined C‐statistics of 0.99 for predicting BPD. Higher TIARI after valve deployment was associated with better survival (hazard ratio: 0.94, P=0.014), while other hemodynamic and imaging parameters did not predict mortality after TAVR. Conclusions Among patients undergoing TAVR, a TIARI measured immediately after valve deployment adds incremental value to guide BPD over aortography and echocardiography. Higher residual TIARI is associated with better survival after TAVR.
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Affiliation(s)
- Arnav Kumar
- Division of CardiologyAndreas Gruentzig Cardiovascular CenterEmory University School of MedicineAtlantaGA
| | - Kimi Sato
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Yash Jobanputra
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Jorge Betancor
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Mohamed Halane
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Robin George
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Kinjal Banerjee
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | - Vivek Menon
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | | | - Wael A. Jaber
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Stephanie Mick
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Lars G. Svensson
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Samir R. Kapadia
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
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12
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Effect of Aortic Regurgitation by Cardiovascular Magnetic Resonance After Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:78-84. [PMID: 31047652 DOI: 10.1016/j.amjcard.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/23/2019] [Accepted: 04/01/2019] [Indexed: 11/21/2022]
Abstract
Cardiovascular magnetic resonance (CMR) has demonstrated a high accuracy for evaluating the severity of aortic regurgitation (AR). However, scarce data exist on the impact of AR as evaluated by CMR on clinical outcomes following transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the impact of AR as determined by CMR on clinical outcomes (mortality, heart failure [HF] hospitalization) post-TAVI. A total of 448 TAVI recipients from 2 centers (mean age: 80 ± 7 years, mean STS: 5.8 ± 5.4%) who survived the periprocedural period with no pacemaker implantation were included. A newer generation transcatheter valve system was used in 213 patients (48%). The CMR examination was performed at a median of 12 (IQR: 7 to 21) days post-TAVI. After a mean follow-up of 24 ± 19 months, a total of 94 patients (21%) had died and 72 patients (16%) had at least 1 hospitalization because of decompensated HF. The aortic regurgitation fraction (RF) as determined by CMR was an independent predictor of mortality (hazard ratio[HR]:1.06 for each increase of 10%, 95% confidence interval [CI]: 1.01 to 1.12, p = 0.03) and HF hospitalization (HR:1.15 for each increase of 10%, 95% CI:1.02 to 1.30, p = 0.02). The rate of moderate-severe CMR-AR defined as a RF ≥30% was 3%, and this was associated with an increased risk of mortality (HR: 2.63, 95% CI: 2.30 to 2.99, p <0.001) and HF hospitalization (HR: 2.96, 95% CI: 1.62 to 5.42, p ˂0.001). A stepwise increase in the risk of mortality and HF hospitalization was observed with an increase in AR severity, with a peak increase among patients with RF ≥30%. In conclusion, our results showed the clinical usefulness of evaluating AR severity by CMR post-TAVI. CMR would be particularly helpful in doubtful cases or those with discordances between echocardiography and clinical data.
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13
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CMR and CT of the Patient With Cardiac Devices. JACC Cardiovasc Imaging 2019; 12:890-903. [DOI: 10.1016/j.jcmg.2018.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
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14
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Kooistra NHM, Nijhoff F, Abawi M, Agostoni P, Araya Roos DM, van Tuijl S, Blanken N, Voskuil M, Doevendans PAFM, Stella PR, Leiner T. Ex Vivo Pilot Study of Cardiac Magnetic Resonance Velocity Mapping for Quantification of Aortic Regurgitation in a Porcine Model in the Presence of a Transcatheter Heart Valve. J Cardiovasc Transl Res 2019; 12:310-320. [PMID: 30877562 PMCID: PMC6708050 DOI: 10.1007/s12265-019-09878-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/22/2019] [Indexed: 11/02/2022]
Abstract
Accuracy of aortic regurgitation (AR) quantification by magnetic resonance (MR) imaging in the presence of a transcatheter heart valve (THV) remains to be established. We evaluated the accuracy of cardiac MR velocity mapping for quantification of antegrade flow (AF) and retrograde flow (RF) across a THV and the optimal slice position to use in cardiac MR imaging. In a systematic and fully controlled laboratory ex vivo setting, two THVs (Edwards SAPIEN XT, Medtronic CoreValve) were tested in a porcine model (n = 1) under steady flow conditions. Results showed a high level of accuracy and precision. For both THVs, AF was best measured at left ventricular outflow tract level, and RF at ascending aorta level. At these levels, MR had an excellent repeatability (ICC > 0.99), with a tendency to overestimate (4.6 ± 2.4% to 9.4 ± 7.0%). Quantification of AR by MR velocity mapping in the presence of a THV was accurate, precise, and repeatable in this pilot study, when corrected for the systematic error and when the best MR slice position was used. Confirmation of these results in future clinical studies would be a step forward in increasing the accuracy of the assessment of paravalvular AR severity.
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Affiliation(s)
- Nynke H M Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Freek Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Masieh Abawi
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Pierfrancesco Agostoni
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.,Department of Cardiology, Hartcentrum ZNA Middelheim, Antwerp, Belgium
| | - Daniël M Araya Roos
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Niels Blanken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Pieter A F M Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Affiliation(s)
- Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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17
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Musa TA, Uddin A, Dobson LE, Swoboda PP, Garg P, Foley JRJ, Malkin C, Plein S, Blackman DJ, Greenwood JP. Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves. J Interv Cardiol 2018; 31:391-399. [PMID: 29696693 DOI: 10.1111/joic.12512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/01/2018] [Accepted: 03/20/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA). BACKGROUND Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes. METHODS Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months. RESULTS CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months. CONCLUSION Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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18
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A Novel Angiographic Quantification of Aortic Regurgitation After TAVR Provides an Accurate Estimation of Regurgitation Fraction Derived From Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Interv 2018; 11:287-297. [DOI: 10.1016/j.jcin.2017.08.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
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19
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Koo HJ, Lee JY, Kim GH, Kang JW, Kim YH, Kim DH, Song JM, Kang DH, Song JK, Lim TH, Yang DH. Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features. Eur Heart J Cardiovasc Imaging 2018; 19:1419-1427. [DOI: 10.1093/ehjci/jex341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/14/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Young-Hak Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, South Korea
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20
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Abdelghani M, Miyazaki Y, de Boer E, Aben JP, van Sloun M, Suchecki T, van 't Veer M, Soliman O, Onuma Y, de Winter R, Tonino P, van de Vosse F, Rutten M, Serruys P. Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation. EUROINTERVENTION 2018; 13:1527-1535. [DOI: 10.4244/eij-d-17-00595] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Schoechlin S, Brennemann T, Allali A, Ruile P, Jander N, Allgeier M, Gick M, Richardt G, Neumann FJ, Abdel-Wahab M. Hemodynamic classification of paravalvular leakage after transcatheter aortic valve implantation compared with angiographic or echocardiographic classification for prediction of 1-year mortality. Catheter Cardiovasc Interv 2017; 91:E56-E63. [DOI: 10.1002/ccd.27384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Simon Schoechlin
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Tim Brennemann
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Abdelhakim Allali
- Department of Cardiology; Heart Center Bad Segeberg, Segeberger Kliniken; Germany
| | - Philip Ruile
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Nikolaus Jander
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Martin Allgeier
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Michael Gick
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Gert Richardt
- Department of Cardiology; Heart Center Bad Segeberg, Segeberger Kliniken; Germany
| | - Franz-Josef Neumann
- Department of Cardiology & Angiology II; University Heart Center Freiburg-Bad Krozingen; Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology; Heart Center Bad Segeberg, Segeberger Kliniken; Germany
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22
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Lee JC, Branch KR, Hamilton-Craig C, Krieger EV. Evaluation of aortic regurgitation with cardiac magnetic resonance imaging: a systematic review. Heart 2017; 104:103-110. [PMID: 28822982 DOI: 10.1136/heartjnl-2016-310819] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/31/2017] [Indexed: 11/03/2022] Open
Abstract
This review summaries the utility, application and data supporting use of cardiac magnetic resonance imaging (CMR) to evaluate and quantitate aortic regurgitation. We systematically searched Medline and PubMed for original research articles published since 2000 that provided data on the quantitation of aortic regurgitation by CMR and identified 11 articles for review. Direct aortic measurements using phase contrast allow quantitation of volumetric flow across the aortic valve and are highly reproducible and accurate compared with echocardiography. However, this technique requires diligence in prescribing the correct imaging planes in the aorta. Volumetric analytic techniques using differences in ventricular volumes are also highly accurate but less than phase contrast techniques and only accurate when concomitant valvular disease is absent. Comparison of both aortic and ventricular data for internal data verification ensures fidelity of aortic regurgitant data. CMR data can be applied to many types of aortic valve regurgitation including combined aortic stenosis with regurgitation, congenital valve diseases and post-transcatheter valve placement. CMR also predicts those patients who progress to surgery with high overall sensitivity and specificity. Future studies of CMR in patients with aortic regurgitation to quantify the incremental benefit over echocardiography as well as prediction of cardiovascular events are warranted.
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Affiliation(s)
- James C Lee
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kelley R Branch
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Christian Hamilton-Craig
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.,Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia.,Department of Cardiology, Heart & Lung Institute, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.,Seattle Adult Congenital Heart Service, University of Washington School of Medicine, Seattle, Washington, USA
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23
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Blackman DJ, Meredith IT, Dumonteil N, Tchétché D, Hildick-Smith D, Spence MS, Walters DL, Harnek J, Worthley SG, Rioufol G, Lefèvre T, Houle VM, Allocco DJ, Dawkins KD. Predictors of Paravalvular Regurgitation After Implantation of the Fully Repositionable and Retrievable Lotus Transcatheter Aortic Valve (from the REPRISE II Trial Extended Cohort). Am J Cardiol 2017; 120:292-299. [PMID: 28535962 DOI: 10.1016/j.amjcard.2017.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
Paravalvular leak (PVL) after transcatheter aortic valve replacement is associated with worse long-term outcomes. The Lotus Valve incorporates an innovative Adaptive Seal designed to minimize PVL. This analysis evaluated the incidence and predictors of PVL after implantation of the Lotus transcatheter aortic valve. The REPRISE II (REpositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System - Evaluation of Safety and Performance) Study With Extended Cohort enrolled 250 high-surgical risk patients with severe symptomatic aortic stenosis. Aortic regurgitation was assessed by echocardiography pre-procedure, at discharge and 30 days, by an independent core laboratory. Baseline and procedural predictors of mild or greater PVL at 30 days (or at discharge if 30-day data were not available) were determined using a multivariate regression model (n = 229). Of the 229 patients, 197 (86%) had no/trace PVL, 30 had mild, and 2 had moderate PVL; no patient had severe PVL. Significant predictors of mild/moderate PVL included device:annulus area ratio (odds ratio [OR] 0.87; 95% CI 0.83 to 0.92; p <0.001), left ventricular outflow tract calcium volume (OR 2.85; 95% CI 1.44 to 5.63; p = 0.003), and annulus area (OR 0.89; 95% CI 0.82 to 0.96; p = 0.002). When the device:annulus area ratio was <1, the rate of mild/moderate PVL was 53.1% (17 of 32). The rates of mild/moderate PVL with 0% to 5%, 5% to 10%, and >10% annular oversizing by area were 17.5% (11 of 63), 2.9% (2 of 70), and 3.2% (2 of 63), respectively. Significant independent predictors of PVL included device:annulus area ratio and left ventricular outflow tract calcium volume. When the prosthetic valve was oversized by ≥5%, the rate of mild or greater PVL was only 3%. In conclusion, the overall rates of PVL with the Lotus Valve are low and predominantly related to device/annulus areas and calcium; these findings have implications for optimal device sizing.
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24
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Frick M, Meyer CG, Kirschfink A, Altiok E, Lehrke M, Brehmer K, Lotfi S, Hoffmann R. Evaluation of aortic regurgitation after transcatheter aortic valve implantation: aortic root angiography in comparison to cardiac magnetic resonance. EUROINTERVENTION 2016; 11:1419-27. [PMID: 25772902 DOI: 10.4244/eijy15m03_06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Aortic regurgitation (AR) is common after transcatheter aortic valve implantation (TAVI). Intraprocedural assessment of AR relies on aortic root angiography. Cardiac magnetic resonance (CMR) phase-contrast mapping of the ascending aorta provides accurate AR quantification. This study evaluated the accuracy of AR grading by aortic root angiography after TAVI in comparison to CMR phase-contrast velocity mapping. METHODS AND RESULTS In 69 patients with TAVI for severe aortic stenosis, post-procedural AR was determined by aortic root angiography with visual assessment according to the Sellers classification and by CMR using phase-contrast velocity mapping for analysis of AR volume and fraction. Spearman's correlation coefficient showed a moderate correlation between angiographic analysis of AR grade and CMR-derived AR volume (r=0.41; p<0.01) as well as AR fraction (r=0.42; p<0.01). There was significant overlap between the angiographic Sellers classes compared to CMR-derived AR fractions. Aortic root angiography with cut-off Sellers grade ≥2 had a sensitivity of 71% and a specificity of 98% to detect AR graded as moderate to severe or severe as defined by CMR. CONCLUSIONS There is only a moderate correlation between aortic root angiography and CMR in the classification of AR severity after TAVI. Alternative imaging including multimodality imaging as well as haemodynamic analysis should therefore be considered for intraprocedural AR assessment and guidance of TAVI procedure in cases of uncertainty in AR grading.
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Affiliation(s)
- Michael Frick
- Medical Clinic I, University RWTH Aachen, Aachen, Germany
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25
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Rationale and design of the Edwards SAPIEN-3 periprosthetic leakage evaluation versus Medtronic CoreValve in transfemoral aortic valve implantation (ELECT) trial : A randomised comparison of balloon-expandable versus self-expanding transcatheter aortic valve prostheses. Neth Heart J 2016; 25:318-329. [PMID: 27943176 PMCID: PMC5405023 DOI: 10.1007/s12471-016-0934-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and objectives Periprosthetic aortic regurgitation (PPR) after transcatheter aortic valve implantation (TAVI) remains an important issue associated with impaired long-term outcomes. The current randomised study aims to evaluate potential differences between the balloon-expandable Edwards SAPIEN-3 and the self-expanding Medtronic CoreValve system with the main focus on post-TAVI PPR by means of novel imaging endpoints, and an additional focus on other clinical endpoints. Endpoints The primary endpoint of this study is quantitative assessment of the severity of post-procedural PPR using cardiac magnetic resonance imaging. Several other novel imaging modalities (X-ray contrast angiography, echocardiography) are used as secondary imaging modalities for the assessment of PPR following TAVI. Secondary objectives of the study include clinical outcomes such as cerebral and kidney injury related to TAVI, and quality of life. Methods and design The ELECT study is a single-centre, prospective, two-armed randomised controlled trial. For the purpose of this study, 108 consecutive adult patients suitable for transfemoral TAVI will be randomly allocated to receive the SAPIEN-3 (n = 54) or the CoreValve system (n = 54). Discussion The ELECT trial is the first randomised controlled trial to quantitatively compare the extent of post-TAVI PPR between the SAPIEN-3 and CoreValve. Furthermore, it will evaluate potential differences between the two prostheses with regard to mid-term clinical outcome and quality of life.
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Geleijnse ML, Di Martino LFM, Vletter WB, Ren B, Galema TW, Van Mieghem NM, de Jaegere PPT, Soliman OII. Limitations and difficulties of echocardiographic short-axis assessment of paravalvular leakage after corevalve transcatheter aortic valve implantation. Cardiovasc Ultrasound 2016; 14:37. [PMID: 27600600 PMCID: PMC5011797 DOI: 10.1186/s12947-016-0080-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/25/2016] [Indexed: 12/20/2022] Open
Abstract
To make assessment of paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) more uniform the second Valve Academic Research Consortium (VARC) recently updated the echocardiographic criteria for mild, moderate and severe PVL. In the VARC recommendation the assessment of the circumferential extent of PVL in the short-axis view is considered critical. In this paper we will discuss our observational data on the limitations and difficulties of this particular view, that may potentially result in overestimation or underestimation of PVL severity.
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Affiliation(s)
- Marcel L Geleijnse
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
| | - Luigi F M Di Martino
- From the department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy
| | - Wim B Vletter
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Ben Ren
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Tjebbe W Galema
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Osama I I Soliman
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.,From the Cardialysis Cardiovascular Core Laboratory, Rotterdam, The Netherlands
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Ribeiro HB, Orwat S, Hayek SS, Larose É, Babaliaros V, Dahou A, Le Ven F, Pasian S, Puri R, Abdul-Jawad Altisent O, Campelo-Parada F, Clavel MA, Pibarot P, Lerakis S, Baumgartner H, Rodés-Cabau J. Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 68:577-585. [DOI: 10.1016/j.jacc.2016.05.059] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/23/2016] [Accepted: 05/07/2016] [Indexed: 11/27/2022]
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Abdelghani M, Tateishi H, Spitzer E, Tijssen JG, de Winter RJ, Soliman OII, Hahn RT, Serruys PW. Echocardiographic and angiographic assessment of paravalvular regurgitation after TAVI: optimizing inter-technique reproducibility. Eur Heart J Cardiovasc Imaging 2016; 17:852-60. [DOI: 10.1093/ehjci/jew083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/30/2016] [Indexed: 02/05/2023] Open
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Abdelghani M, Soliman OI, Schultz C, Vahanian A, Serruys PW. Adjudicating paravalvular leaks of transcatheter aortic valves: a critical appraisal. Eur Heart J 2016; 37:2627-44. [DOI: 10.1093/eurheartj/ehw115] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 03/01/2016] [Indexed: 12/18/2022] Open
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Abdelghani M, Serruys PW. Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2016; 9:e002944. [DOI: 10.1161/circinterventions.115.002944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients’ risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
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Affiliation(s)
- Mohammad Abdelghani
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
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31
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Sustitución percutánea de válvula aórtica: ventajas y limitaciones de diferentes técnicas de imagen cardiaca. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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32
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Cavalcante JL, Lalude OO, Schoenhagen P, Lerakis S. Cardiovascular Magnetic Resonance Imaging for Structural and Valvular Heart Disease Interventions. JACC Cardiovasc Interv 2016; 9:399-425. [DOI: 10.1016/j.jcin.2015.11.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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MRI evaluation prior to Transcatheter Aortic Valve Implantation (TAVI): When to acquire and how to interpret. Insights Imaging 2016; 7:245-54. [PMID: 26911969 PMCID: PMC4805621 DOI: 10.1007/s13244-016-0470-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/07/2016] [Accepted: 01/26/2016] [Indexed: 12/18/2022] Open
Abstract
Transcatheter Aortic Valve Implantation (TAVI) is increasingly being used in patients with severe aortic stenosis who are not candidates for surgery. ECG-gated CT angiography (CTA) plays an important role in the preoperative planning for these devices. As the number of patients undergoing these procedures increases, a subset of patients is being recognized who have contraindications to iodinated contrast medium, either due to a prior severe allergic type reaction or poor renal function. Another subgroup of patients with low flow and low gradient aortic stenosis is being recognized that are usually assessed for severity of aortic stenosis by stress echocardiography. There are contraindications to stress echocardiography and some of these patients may not be able to undergo this test. Non-contrast MRI can be a useful emerging modality for evaluating these patients. In this article, we discuss the emerging indications of non-contrast MRI in preoperative assessment for TAVI and describe the commonly used MRI sequences. A comparison of the most important measurements obtained for TAVI assessment on CTA and MRI from same subjects is included. Teaching Points • MRI can be used for preoperative assessment of aortic annulus. • MRI is an alternate to CTA when iodinated contrast is contraindicated. • Measurements obtained by non-contrast MRI are similar to contrast enhanced CTA. • MRI can be used to assess severity of aortic stenosis.
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Update: Cardiac Imaging (II). Transcatheter Aortic Valve Replacement: Advantages and Limitations of Different Cardiac Imaging Techniques. ACTA ACUST UNITED AC 2016; 69:310-21. [PMID: 26856791 DOI: 10.1016/j.rec.2015.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve replacement is an established therapy for patients with symptomatic severe aortic stenosis and contraindications or high risk for surgery. Advances in prostheses and delivery system designs and continuous advances in multimodality imaging, particularly the 3-dimensional techniques, have led to improved outcomes with significant reductions in the incidence of frequent complications such as paravalvular aortic regurgitation. In addition, data on prosthesis durability are accumulating. Multimodality imaging plays a central role in the selection of patients who are candidates for transcatheter aortic valve replacement, procedure planning and guidance, and follow-up of prosthesis function. The strengths and limitations of each imaging technique for transcatheter aortic valve replacement will be discussed in this update article.
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Salaun E, Jacquier A, Theron A, Giorgi R, Lambert M, Jaussaud N, Hubert S, Collart F, Bonnet J, Habib G, Cuisset T, Grisoli D. Value of CMR in quantification of paravalvular aortic regurgitation after TAVI. Eur Heart J Cardiovasc Imaging 2015; 17:41-50. [DOI: 10.1093/ehjci/jev177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/18/2015] [Indexed: 11/13/2022] Open
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Agarwal S, Parashar A, Kumbhani DJ, Svensson LG, Krishnaswamy A, Tuzcu EM, Kapadia SR. Comparative meta-analysis of balloon-expandable and self-expandable valves for transcatheter aortic valve replacement. Int J Cardiol 2015; 197:87-97. [PMID: 26117654 DOI: 10.1016/j.ijcard.2015.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/06/2015] [Accepted: 06/12/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Balloon-expandable valves (BEVs) and self-expandable valves (SEVs) are two major types of valves utilized for transcatheter aortic valve replacement (TAVR). We conducted a meta-analysis of available studies to compare the safety and efficacy of these two valve types. METHODS Medline search was conducted using standard search terms to determine eligible studies. Primary outcomes of the meta-analysis included death and stroke at 30days and 1year. Pooled estimates of procedural outcomes were also compared between the valve types. Analysis was performed for entire cohort and separately for patients undergoing transfemoral TAVR (TF-TAVR). RESULTS Analysis of entire cohort revealed similar 30-day mortality in the SEV and BEV cohorts. There was no significant difference in the incidence of stroke at 30days between the two study groups. Both pooled comparisons demonstrated a significant heterogeneity with I(2)>50%, necessitating the use of random effect modeling. We observed a significantly higher incidence of new pacemaker implantation, aortic regurgitation≥2+ at 30days, valve embolization, and need for >1 valve following SEV implantation compared with BEV implantation. Analysis of TF-TAVR cohort showed higher 30day [IRR (95% CI): 1.34 (1.19-1.52)] but a similar 1-year mortality [IRR (95% CI): 1.07 (0.96-1.19)] for SEV compared to BEV implantation. CONCLUSION Compared to BEV implantation, SEV implantation was associated with a similar risk of mortality and stroke at 30-day and 1-year follow-up duration. Analysis of the TF-TAVR cohort revealed a significantly higher mortality at 30days among patients undergoing SEV implantation, compared with BEV implantation. In addition, there was a significantly higher incidence of other adverse events noted above, following SEV implantation, compared with BEV implantation.
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Affiliation(s)
- Shikhar Agarwal
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Akhil Parashar
- Department of Internal Medicine, Cleveland Clinic, United States
| | - Dharam J Kumbhani
- Interventional Cardiology, UT Southwestern Medical Center, United States
| | - Lars G Svensson
- Department of Cardiovascular Surgery, Cleveland Clinic, United States
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, J2-3, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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Crouch G, Tully PJ, Bennetts J, Sinhal A, Bradbrook C, Penhall AL, De Pasquale CG, Baker RA, Selvanayagam JB. Quantitative assessment of paravalvular regurgitation following transcatheter aortic valve replacement. J Cardiovasc Magn Reson 2015; 17:32. [PMID: 25953135 PMCID: PMC4423485 DOI: 10.1186/s12968-015-0134-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Paravalvular aortic regurgitation (PAR) following transcatheter aortic valve implantation (TAVI) is well acknowledged. Despite improvements, echocardiographic measurement of PAR largely remains qualitative. Cardiovascular magnetic resonance (CMR) directly quantifies AR with accuracy and reproducibility. We compared CMR and transthoracic echocardiography (TTE) analysis of pre-operative and post-operative aortic regurgitation in patients undergoing both TAVI and surgical aortic valve replacement (AVR). METHODS Eighty-seven patients with severe aortic stenosis undergoing TAVI (56 patients) or AVR were recruited. CMR (1.5 T) and transthoracic echocardiography (TTE) were carried out pre-operatively and a median of 6 days post-operatively. The CMR protocol included regurgitant aortic flows using through-plane phase-contrast velocity. None/trivial, mild, moderate and severe AR by CMR was defined as ≤8%, 9-20%, 21-39%, >40% regurgitant fractions respectively. RESULTS Pre- and post-operative left ventricular ejection fraction (LVEF) was similar. Post-procedure aortic regurgitant fraction using CMR was higher in the TAVI group (TAVI 16 ± 13% vs. AVR 4 ± 4%, p < 0.01). Comparing CMR to TTE, 27 of 56 (48%) TAVI patients had PAR which was at least one grade more severe on CMR than TTE (Z = -4.56, p <0.001). Sensitivity analysis confirmed the difference in PAR grade between TTE and CMR in the TAVI group (Z = -4.49, p < 0.001). CONCLUSION When compared to CMR based quantitative analysis, TTE underestimated the degree of paravalvular aortic regurgitation. This underestimation may in part explain the findings of increased mortality associated with mild or greater AR by TTE in the PARTNER trial. Paravalvular aortic regurgitation post TAVI assessed as mild by TTE may in fact be more severe.
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Affiliation(s)
- Gareth Crouch
- South Australian Health and Medical Research Institute, Adelaide, Australia.
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
- Flinders University of South Australia, Adelaide, SA, Australia.
| | - Phillip J Tully
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
| | - Jayme Bennetts
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Craig Bradbrook
- South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Amy L Penhall
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Carmine G De Pasquale
- South Australian Health and Medical Research Institute, Adelaide, Australia.
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Robert A Baker
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
- Flinders University of South Australia, Adelaide, SA, Australia.
| | - Joseph B Selvanayagam
- South Australian Health and Medical Research Institute, Adelaide, Australia.
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
- Flinders University of South Australia, Adelaide, SA, Australia.
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Feltes G, Núñez-Gil IJ. Practical update on imaging and transcatheter aortic valve implantation. World J Cardiol 2015; 7:178-186. [PMID: 25914787 PMCID: PMC4404373 DOI: 10.4330/wjc.v7.i4.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/26/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
After very rapid advances in the development of the technique and devices, transcatheter aortic valve implantation (named TAVI or TAVR), is today a reality that is here to stay. It has become the minimally-invasive treatment option for high-risk and non-surgical patients with severe symptomatic aortic stenosis. Requiring the participation of a multidisciplinary team for its implementation, cardiac imaging plays an important role. From pre-assessment to determine the suitability of the patient, the access site, the type of device, to the guidance during the procedure, and ultimately the long term monitoring of the patient. Correct selection of the patient and device, correct placement of the stent-valve and early detection of complications are of paramount importance for procedural success and for patient outcome. Each technique has advantages and disadvantages, being the cardiologist who will determine the best approach according to the type of patient and the expertise of the center in each one of them. This article summarizes the last contributions of the most common used imaging techniques, in each step of the procedure.
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Schultz CJ, Slots TLB, Yong G, Aben JP, Van Mieghem N, Swaans M, Rahhab Z, El Faquir N, van Geuns R, Mast G, Zijlstra F, de Jaegere PPT. An objective and reproducible method for quantification of aortic regurgitation after TAVI. EUROINTERVENTION 2015; 10:355-63. [PMID: 24832213 DOI: 10.4244/eijy14m05_06] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We describe a new semi-automated method that measures aortic regurgitation (AR) on contrast aortography with the objectives of reducing the inter-observer variability and standardising image acquisition. METHODS AND RESULTS Aortograms from three participating centres were reviewed to generate the following quality criteria: entire left ventricle and aortic root in view, descending aorta or TOE probe not over-projected, breath hold, no table motion, and adequate contrast opacification of the aortic root. AR was visually graded (Sellers) and was quantified by measuring the area under time-contrast density curves in the aortic root (reference) and the left ventricle. Quality criteria were met in 44 retrospectively identified aortograms and in 22 (69%) of 32 prospectively collected aortograms. The visual AR grade (Sellers) was highly correlated with time-density measurements including relative area under the curve (RAUC) and qRA index (r=0.81 and 0.83, respectively, p<0.001). Inter-observer reproducibility of visual grading was moderate (kappa 0.47-0.60, p<0.001). Inter-observer measurement of RAUC and qRA index were highly correlated (r=0.98, p<0.001) and showed a high level of agreement. CONCLUSIONS Quantification of aortic regurgitation by measurement of time-density changes on contrast aortography may improve the reproducibility of AR assessment in the catheter laboratory. Steps for standardised aortography acquisition are proposed.
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Affiliation(s)
- Carl J Schultz
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of Paravalvular Regurgitation Following TAVR. JACC Cardiovasc Imaging 2015; 8:340-360. [DOI: 10.1016/j.jcmg.2015.01.008] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 01/23/2023]
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Impact and Management of Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2015; 4:67-82. [PMID: 28582123 DOI: 10.1016/j.iccl.2014.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Paravalvular regurgitation (PVR) is a frequent complication of transcatheter aortic valve replacement that has been shown to be associated with increased mortality. The objective of this article was to review the most up-to-date information about the impact and management of PVR. A multimodality, multiparametric, integrative approach including angiography, Doppler echocardiography, and/or cardiac MR is essential to accurately assess the severity of PVR and the underlying etiology. Corrective procedures such as balloon postdilation, valve-in-valve, or leak closure may be considered, depending on the severity, location, and etiology of PVR.
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Hahn RT. Assessment of Paravalvular Regurgitation Following Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2015; 4:53-66. [PMID: 28582122 DOI: 10.1016/j.iccl.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Paravalvular regurgitation (PVR) following transcatheter aortic valve replacement is a known complication associated with poorer outcomes. This article discusses the current techniques for assessing the severity of PVR, including angiography, hemodynamics, MRI, and echocardiography. The strengths and pitfalls of each modality are reviewed.
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Affiliation(s)
- Rebecca T Hahn
- Center for Interventional Vascular Therapy, Columbia University Medical Center, New York-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032, USA.
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43
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van der Boon RM, Houthuizen P, Urena M, Poels TT, van Mieghem NM, Brueren GR, Altintas S, Nuis RJ, Serruys PW, van Garsse LA, van Domburg RT, Cabau JR, de Jaegere PP, Prinzen FW. Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2014; 85:E144-52. [DOI: 10.1002/ccd.25765] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/30/2014] [Indexed: 01/29/2023]
Affiliation(s)
| | - Patrick Houthuizen
- Catharina Hospital; Eindhoven The Netherlands
- Cardiovascular Research Institute Maastricht; Maastricht The Netherlands
| | - Marina Urena
- Quebec Heart & Lung Institute, Laval University; Quebec City Canada
| | - Thomas T. Poels
- Maastricht University Medical Center; Maastricht The Netherlands
| | | | | | - Sibel Altintas
- Maastricht University Medical Center; Maastricht The Netherlands
| | | | | | | | | | | | | | - Frits W. Prinzen
- Cardiovascular Research Institute Maastricht; Maastricht The Netherlands
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Hartlage GR, Babaliaros VC, Thourani VH, Hayek S, Chrysohoou C, Ghasemzadeh N, Stillman AE, Clements SD, Oshinski JN, Lerakis S. The role of cardiovascular magnetic resonance in stratifying paravalvular leak severity after transcatheter aortic valve replacement: an observational outcome study. J Cardiovasc Magn Reson 2014; 16:93. [PMID: 25475485 PMCID: PMC4256820 DOI: 10.1186/s12968-014-0093-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) confers a worse prognosis. Symptoms related to significant PVL may be difficult to differentiate from those related to other causes of heart failure. Cardiovascular magnetic resonance (CMR) directly quantifies valvular regurgitation, but has not been extensively studied in symptomatic post-TAVR patients. METHODS CMR was compared to qualitative (QE) and semi-quantitative echocardiography (SQE) for classifying PVL and prognostic value at one year post-imaging in 23 symptomatic post-TAVR patients. The primary outcome was a composite of all-cause death, heart failure hospitalization, and intractable symptoms necessitating repeat invasive therapy; the secondary outcome was a composite of all-cause death and heart failure hospitalization. The difference in event-free survival according to greater than mild PVL versus mild or less PVL by QE, SQE, and CMR were evaluated by Kaplan-Meier survival analysis. RESULTS Compared to QE, CMR reclassified PVL severity in 48% of patients, with most patients (31%) reclassified to at least one grade higher. Compared to SQE, CMR reclassified PVL severity in 57% of patients, all being reclassified to at least one grade lower; SQE overestimated PVL severity (mean grade 2.5 versus 1.7, p=0.001). The primary and secondary outcomes occurred in 48% and 35% of patients, respectively. Greater than mild PVL by CMR was associated with reduced event-free survival for the primary outcome (p<0.0001), however greater than mild PVL by QE and SQE were not (p=0.83 and p=0.068). Greater than mild PVL by CMR was associated with reduced event-free survival for the secondary outcome, as well (p=0.012). CONCLUSION In symptomatic post-TAVR patients, CMR commonly reclassifies PVL grade compared with QE and SQE. CMR provides superior prognostic value compared to QE and SQE, as patients with greater than mild PVL by CMR (RF>20%) had a higher incidence of adverse events.
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Affiliation(s)
- Gregory R Hartlage
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
- />Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA Georgia
| | - Vasilis C Babaliaros
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- />Department of Surgery, Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Salim Hayek
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Christina Chrysohoou
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Ghasemzadeh
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Arthur E Stillman
- />Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA Georgia
| | - Stephen D Clements
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - John N Oshinski
- />Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA Georgia
- />Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia
| | - Stamatios Lerakis
- />Department of Medicine, Division of Cardiology, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
- />Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA Georgia
- />Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia
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Maisano F, Taramasso M, Nietlispach F. Prognostic influence of paravalvular leak following TAVI: is aortic regurgitation an active incremental risk factor or just a mere indicator? Eur Heart J 2014; 36:413-5. [PMID: 25336227 DOI: 10.1093/eurheartj/ehu410] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Francesco Maisano
- Cardiovascular Surgery Clinic, Herzzentrum, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Cardiovascular Surgery Clinic, Herzzentrum, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Fabian Nietlispach
- Cardiology Clinic, Herzzentrum, UniversitätsSpital Zürich, Zürich, Switzerland
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46
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Sordelli C, Severino S, Ascione L, Coppolino P, Caso P. Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr 2014; 24:103-113. [PMID: 28465917 PMCID: PMC5353566 DOI: 10.4103/2211-4122.147201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients submitted to valve replacement with mechanical or biological prosthesis, may present symptoms related either to valvular malfunction or ventricular dysfunction from other causes. Because a clinical examination is not sufficient to evaluate a prosthetic valve, several diagnostic methods have been proposed to assess the functional status of a prosthetic valve. This review provides an overview of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. Compared to native valves, echocardiographic evaluation of prosthetic valves is certainly more complex, both for the examination and the interpretation. Echocardiography also allows discriminating between intra- and/or peri-prosthetic regurgitation, present in the majority of mechanical valves. Transthoracic echocardiography (TTE) requires different angles of the probe with unconventional views. Transesophageal echocardiography (TEE) is the method of choice in presence of technical difficulties. Three-dimensional (3D)-TEE seems to be superior to 2D-TEE, especially in the assessment of paravalvular leak regurgitation (PVL) that it provides improved localization and analysis of the PVL size and shape.
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Affiliation(s)
- Chiara Sordelli
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Sergio Severino
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| | - Luigi Ascione
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| | | | - Pio Caso
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
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Salgado RA, Budde RPJ, Leiner T, Shivalkar B, Van Herck PL, Op de Beeck BJ, Vrints C, Buijsrogge MP, Stella PR, Rodrigus I, Bosmans J, Parizel PM. Transcatheter Aortic Valve Replacement: Postoperative CT Findings of Sapien and CoreValve Transcatheter Heart Valves. Radiographics 2014; 34:1517-36. [DOI: 10.1148/rg.346130149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Abdel-Wahab M, Richardt G. Selection of TAVI prostheses: do we really have the CHOICE? EUROINTERVENTION 2014; 10 Suppl U:U28-34. [DOI: 10.4244/eijv10sua5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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49
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Bax JJ, Delgado V, Bapat V, Baumgartner H, Collet JP, Erbel R, Hamm C, Kappetein AP, Leipsic J, Leon MB, MacCarthy P, Piazza N, Pibarot P, Roberts WC, Rodés-Cabau J, Serruys PW, Thomas M, Vahanian A, Webb J, Zamorano JL, Windecker S. Open issues in transcatheter aortic valve implantation. Part 2: procedural issues and outcomes after transcatheter aortic valve implantation. Eur Heart J 2014; 35:2639-54. [DOI: 10.1093/eurheartj/ehu257] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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50
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When to consider cardiovascular magnetic resonance in patients undergoing transcatheter aortic valve replacement? Curr Opin Cardiol 2014; 28:505-11. [PMID: 23852024 DOI: 10.1097/hco.0b013e32836245fb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To discuss the relevant techniques as well as the recent evidence that enhance the understanding of the reader on the applications of cardiovascular magnetic resonance (CMR) in transcatheter aortic valve replacement (TAVR). With different cardiac imaging modalities available as well as the advent of TAVR, it is important to define when CMR can be helpful in the periprocedural evaluation. RECENT FINDINGS The topics of interest covered in this review are CMR evaluation of aortic stenosis/regurgitation, TAVR sizing, vascular measurements for access planning, postimplantation paravalvular regurgitation (PVR), and the potential role of delayed enhancement assessment in patients undergoing TAVR. SUMMARY CMR is a complementary modality in the assessment of TAVR candidates. The ability of CMR to assess the hemodynamic significance of aortic stenosis and other valvulopathies, as well as to assess accurately the left ventricular ejection fraction and vascular anatomy, makes this technique well rounded. The roles of delayed enhancement for myocardial scar in the evaluation of TAVR candidates and PVR assessment in the postimplant patient are promising, but still yet to be fully defined.
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