Key result
A semi-automated method quantifying aortic regurgitation via time-density changes on contrast aortography highly correlated with visual grading (r=0.81-0.83, p<0.001) with high inter-observer agreement.
Why the study?
Does semi-automated quantification of aortic regurgitation using time-density curves improve inter-observer reproducibility compared to visual grading after TAVI?
Observational (n=76)
Yes
Does semi-automated quantification of aortic regurgitation using time-density curves improve inter-observer reproducibility compared to visual grading after TAVI?
Effect estimate: r=0.81 and 0.83
p-value: p=<0.001
A novel semi-automated method using time-density changes on contrast aortography provides highly reproducible quantification of aortic regurgitation after TAVI, outperforming standard visual grading.
May support reproducible post-TAVI AR quantification; leaves open superiority to visual grading pending prospective validation.
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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Schultz et al. (2014) conducted an observational in Aortic regurgitation after TAVI (n=76). Semi-automated time-contrast density curve measurement (RAUC and qRA index) vs. Visual grading (Sellers) was evaluated on Correlation between visual AR grade and time-density measurements (RAUC and qRA index) (r=0.81 and 0.83, p=<0.001). A semi-automated method quantifying aortic regurgitation via time-density changes on contrast aortography highly correlated with visual grading (r=0.81-0.83, p<0.001) with high inter-observer agreement.
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