Transthoracic echocardiography using VARC-II criteria showed modest agreement with angiography for grading post-TAVI paravalvular aortic regurgitation (53% agreement, k = 0.14).
Observational (n=165)
Does a combination of colour Doppler and hemodynamic parameters on TTE improve agreement with angiography in assessing paravalvular aortic regurgitation after TAVI?
Agreement between angiography and TTE using standard VARC-II criteria for grading post-TAVI paravalvular AR is modest, but can be improved by combining colour Doppler and hemodynamic parameters.
Effect estimate: k = 0.14
AIMS: Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is often first diagnosed by angiography and then confirmed and followed-up by transthoracic echocardiography (TTE). Consistency between both methods is important for follow-up. We sought to determine inter-technique reproducibility of the assessment of paravalvular AR after TAVI. METHODS AND RESULTS: The study included 165 patients treated with a self-expanding bioprosthesis and had angiography and TTE performed at a median interval of 4 days. TTE parameters of AR severity included VARC score (the average AR grade determined by the echocardiographic VARC-II criteria), pressure half time (PHT), regurgitation jet features in long-axis views (LAX score) and colour Doppler (CD) score (=paravalvular AR jet circumferential extent (%) + LAX score). Using receiver-operating characteristics curves, the cut-points that best defined an angiographic >mild AR were identified.On TTE, AR was paravalvular in all cases, multi-jet in 28%, and predominantly (64%) detected in the commissural region between the right and left coronary sinuses. Using VARC-II criteria (combining at least two), TTE agreed with angiographic classification in 53% of cases (k = 0.14). Greater than mild AR could better be defined by one of the following combinations of criteria: (i) LAX score >4.25 and VARC-II score >1.33; (ii) CD score >11.5 and PHT <400 ms. The combination of the CD score with PHT gave the best sum of sensitivity, specificity, positive, and negative predictive values. CONCLUSIONS: Agreement between angiography and TTE (using the VARC-II criteria) in the grading of post-TAVI AR is modest, and this might have contributed to the inconsistency of data on the rate and fate of paravalvular AR. Inter-technique reproducibility can be improved using a combination of CD and hemodynamic parameters.
Abdelghani et al. (Wed,) conducted a observational in Paravalvular aortic regurgitation after TAVI (n=165). Transthoracic echocardiography (TTE) vs. Angiography was evaluated on Agreement between TTE (using VARC-II criteria) and angiographic classification of paravalvular AR (k = 0.14). Transthoracic echocardiography using VARC-II criteria showed modest agreement with angiography for grading post-TAVI paravalvular aortic regurgitation (53% agreement, k = 0.14).