Key result
Peri-interventional aortic regurgitation ratio predicts TAVI paravalvular leak requiring post-dilation better than calcium score.
Why the study?
Tools are needed to assist interventionists in selecting patients for post-dilation, and it was unclear whether pre-interventional aortic valve calcium or the peri-interventional aortic regurgitation ratio better predicts more than mild paravalvular leak requiring post-dilation after TAVI.
Does the peri-interventional ARI ratio predict moderate-to-severe paravalvular leak requiring post-dilation better than pre-procedural aortic valve calcium score in patients undergoing TAVI?
Cohort (n=237)
Does the peri-interventional ARI ratio predict moderate-to-severe paravalvular leak requiring post-dilation better than pre-procedural aortic valve calcium score in patients undergoing TAVI?
The peri-interventional ARI ratio is a superior predictor of moderate-to-severe paravalvular leak requiring post-dilation after TAVI compared to pre-procedural MSCT-derived aortic valve calcification.
Answers are grounded in this paper and cite their sources.
May aid identification of TAVI patients needing post-dilation; hypothesis-generating and requires prospective validation before practice change.
Background and aim: Tools that assist interventionists in selecting patients for post-dilation (PD) are needed. We aimed to assess whether pre-interventional aortic valve calcium (AVC) or the peri-interventional aortic regurgitation (ARI) ratio is a better predictor for a more than mild paravalvular leak (PVL) requiring PD after TAVI. Methods: Patients undergoing TAVI with available data on AVC derived from MSCTs and the ARI ratio derived from peri-interventional hemodynamic curves were studied. The main outcome was moderate-to-severe PVL requiring PD. Results: In 237 patients, more than mild PVL after valve deployment was present in 25.7%. PD was performed in 65 patients. The median (IQR) total AVC was 390.5 (211.5–665.4) mm3. All calcification values were significantly higher in patients who underwent PD. The median (IQR) individual threshold was 600 (550–685) Hus. The overall ARI ratio was 0.78 (0.61–0.96), with values being significantly lower in patients who underwent PD: 0.61 (0.49–0.80) vs. 0.82 (0.69–0.99) (p < 0.001). Both the ARI ratio (OR [95%CI] 0.053 [0.014–0.203]; p < 0.001) and AVC (1.01 [1.000–1.002]; p = 0.015) predicted PD need. ROC curves showed higher discrimination for the ARI ratio (AUC 0.73) than for any calcification parameter (all AUCs ≤ 0.62). Conclusions: The ARI ratio provides interventionists with a powerful predictive tool for PVL requiring PD after TAVI that is beyond the predictive value of pre-procedural valve calcification derived from MSCT.
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Uebelacker et al. (2023) conducted a cohort in Transcatheter Aortic Valve Implantation (TAVI) (n=237). Peri-interventional aortic regurgitation (ARI) ratio vs. Pre-interventional aortic valve calcium (AVC) score was evaluated on Moderate-to-severe paravalvular leak requiring post-dilation (OR 0.053, 95% CI 0.014-0.203, p=<0.001). The peri-interventional aortic regurgitation ratio predicted paravalvular leak requiring post-dilation after TAVI better than aortic valve calcium score.
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