Angiographic assessment of aortic regurgitation by video‐densitometry in the setting of TAVI: Echocardiographic and clinical correlates

Objectives We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI). Background AR after TAVI is common but challenging to quantitate, especially in the cath‐lab. Methods In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video‐densitometric analysis of aortograms. Contrast time–density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT‐AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region. Results LVOT‐AR was 0.10 ± 0.08, 0.13 ± 0.10 and 0.28 ± 0.14 in none‐trace, mild and moderate‐severe post‐TAVI AR as defined by echocardiography ( P < 0.001) and a cutpoint of >0.17 corresponded to moderate‐severe AR on echocardiography (area under the curve = 0.84). At follow‐up (median, 496 days), patients with LVOT‐AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95–148] vs. 140 [112–169] g/m 2 , P = 0.009) and the prevalence of LV hypertrophy (LVH; 64 vs. 88%, P = 0.001) compared to baseline. In patients with LVOT‐AR > 0.17, LVMi (149 [121–178] vs. 166 [144–188] g/m 2 , P = 0.14) and the prevalence of LVH (74 vs. 87%, P = 0.23) did not show a significant change. Compared to patients with LVOT‐AR ≤ 0.17, those with LVOT‐AR > 0.17 had an increased 30‐day (16.4% vs. 7.1%, P = 0.035) and one year mortality (32.9 vs. 14.2%, log rank P value = 0.001; HR: 2.690 [1.461–4.953], P = 0.001). Conclusions LVOT‐AR > 0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI.