Pre-Procedural Hemodynamic Status Improves the Discriminatory Value of the Aortic Regurgitation Index in Patients Undergoing Transcatheter Aortic Valve Replacement

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• 作者：Jan-Malte Sinning ; MD^a ; ^{jan-malte.sinning@ukb.uni-bonn.de" class="auth_mail" title="E-mail the corresponding author} ; Anja Stundl ; MD^a ; Simon Pingel ; MD^a ; Marcel Weber ; MD^a ; Alexander Sedaghat ; MD^a ; Christoph Hammerstingl ; MD^a ; Mariuca Vasa-Nicotera ; MD^a ; Fritz Mellert ; MD^b ; Wolfgang Schiller ; MD^b ; Jan Kovac ; MD^c ; ^d ; Armin Welz ; MD^b ; Eberhard Grube ; MD^a ; Nikos Werner ; MD^a ; Georg Nickenig ; MD^a
• 关键词：aortic stenosis ; AR index ; hemodynamic status ; paravalvular leakage ; paravalvular regurgitation ; TAVI ; TAVR
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：11 April 2016
• 年：2016
• 卷：9
• 期：7
• 页码：700-711
• 全文大小：1824 K

文摘

The aims of this study were to increase the discriminatory value of the aortic regurgitation index (ARI) for the assessment of paravalvular regurgitation (PVR) and to further elucidate the association between aortic regurgitation severity and mortality after transcatheter aortic valve replacement (TAVR).

Background

Hemodynamic parameters such as the ARI complement predominantly angiographically guided TAVR. However, the ARI depends on several baseline and periprocedural characteristics.

Methods

The ARI was prospectively calculated before and after TAVR in 600 patients. The severity of PVR was assessed in all patients by angiography and echocardiography according to a 3-class scheme. To account for pre-procedural hemodynamic status, the ARI ratio was calculated as post- over pre-procedural ARI.

Results

Apart from the degree of PVR (β = −0.396, p < 0.001), pre-procedural hemodynamic status in the form of the ARI before TAVR (β = 0.227, p < 0.001) was associated with post-procedural ARI in multivariate regression analysis. The ARI ratio increased the specificity of post-procedural ARI alone for the prediction of both more than mild PVR and 1-year mortality from 75.1% to 93.2% and from 75.0% to 93.3%, respectively. Patients with post-procedural ARI values <25 after TAVR had significantly increased 1-year mortality only when the ARI ratio was <0.60 (50.0% vs. 26.3%, p = 0.001).

Conclusions

The ARI ratio integrating pre- and post-procedural hemodynamic status increases the discriminatory value of post-procedural ARI. The ARI ratio, which reflects acute hemodynamic changes after TAVR, is useful to identify patients with negative outcomes.