What is the clinical evidence from this study?

Study design: Cohort. Population: Transcatheter Aortic Valve Implantation (TAVI) (n=146). Intervention: Aortic regurgitation (AR) index <25 vs. AR index ≥25. Primary outcome: 1-year mortality (HR 2.9, 95% CI 1.3 to 6.4, p=0.009).

What question did this study set out to answer?

To establish a reproducible point-of-care hemodynamic assessment of peri-prosthetic aortic regurgitation during transcatheter aortic valve implantation and assess its impact on clinical outcomes.

August 29, 2026Journal of the American College of Cardiology407 citationsOpen Access

Aortic Regurgitation Index Defines Severity of Peri-Prosthetic Regurgitation and Predicts Outcome in Patients After Transcatheter Aortic Valve Implantation

Q: What are the key findings of this study?

An aortic regurgitation index <25 after TAVI independently predicted higher 1-year mortality compared to an index ≥25 (46.0% vs. 16.7%; HR 2.9, 95% CI 1.3-6.4, p=0.009).

Q: What question did this study set out to answer?

To establish a reproducible point-of-care hemodynamic assessment of peri-prosthetic aortic regurgitation during transcatheter aortic valve implantation and assess its impact on clinical outcomes.

JSJan‐Malte Sinning CHChristoph Hammerstingl MVMariuca Vasa‐Nicotera

Key Result

An aortic regurgitation index <25 after TAVI independently predicted higher 1-year mortality compared to an index ≥25 (46.0% vs. 16.7%; HR 2.9, 95% CI 1.3-6.4, p=0.009).

Key Points

To establish a reproducible point-of-care hemodynamic assessment of peri-prosthetic aortic regurgitation during transcatheter aortic valve implantation and assess its impact on clinical outcomes.
Prospective evaluation of 146 patients undergoing transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve prosthesis.
Peri-prosthetic regurgitation was evaluated via echocardiography, angiography, and hemodynamic calculation of the aortic regurgitation (AR) index: [(diastolic blood pressure - left ventricular end-diastolic pressure) / systolic blood pressure] × 100.
AR index decreased stepwise with increasing peri-prosthetic AR severity: 31.7 ± 10.4 for none (36.3%), 28.0 ± 8.5 for mild (48.6%), 19.6 ± 7.6 for moderate (12.3%), and 7.6 ± 2.6 for severe (2.7%; p < 0.001).
Patients with an AR index <25 had significantly increased 1-year mortality compared to those with an AR index ≥25 (46.0% vs. 16.7%; p < 0.001).
AR index independently predicted 1-year mortality (HR: 2.9, 95% CI: 1.3 to 6.4; p = 0.009), providing prognostic value complementary to echocardiography.

Study Design

Type

Cohort (n=146)

Structured PICO

Does the aortic regurgitation (AR) index predict 1-year mortality in patients undergoing TAVI?

Population

146 patients treated with the Medtronic CoreValve prosthesis undergoing TAVI, evaluated for peri-prosthetic aortic regurgitation and followed for 1 year.

Exposure

Measurement of the aortic regurgitation (AR) index (calculated as [(DBP - LVEDP)/SBP] × 100)

Comparator

AR index ≥25 vs <25, and echocardiographically assessed severity of peri-prosthetic aortic regurgitation

Outcome

1-year mortalityhard clinical

The AR index is a simple hemodynamic parameter that accurately quantifies peri-prosthetic aortic regurgitation and independently predicts 1-year mortality after TAVI.

Main Result

Hazard Ratio: 2.9 (95% CI 1.3–6.4)

Absolute Event Rate: 46% vs 16.7%

p-value: p=0.009

Abstract

OBJECTIVES: The aim of this study was to provide a simple, reproducible, and point-of-care assessment of peri-prosthetic aortic regurgitation (periAR) during transcatheter aortic valve implantation (TAVI) and to decipher the impact of this peri-procedural parameter on outcome. BACKGROUND: Because periAR after TAVI might be associated with adverse outcome, precise quantification of periAR is of paramount importance but remains technically challenging. METHODS: The severity of periAR was prospectively evaluated in 146 patients treated with the Medtronic CoreValve (Minneapolis, Minnesota) prosthesis by echocardiography, angiography, and measurement of the aortic regurgitation (AR) index, which is calculated as ratio of the gradient between diastolic blood pressure (DBP) and left ventricular end-diastolic pressure (LVEDP) to systolic blood pressure (SBP): (DBP - LVEDP)/SBP × 100. RESULTS: After TAVI, 53 patients (36.3%) showed no signs of periAR and 71 patients (48.6%) showed only mild periAR, whereas 18 patients (12.3%) and 4 patients (2.7%) suffered from moderate and severe periAR, respectively. The AR index decreased stepwise from 31.7 ± 10.4 in patients without periAR, to 28.0 ± 8.5 with mild periAR, 19.6 ± 7.6 with moderate periAR, and 7.6 ± 2.6 with severe periAR (p < 0.001), respectively. Patients with AR index <25 had a significantly increased 1-year mortality risk compared with patients with AR index ≥25 (46.0% vs. 16.7%; p < 0.001). The AR index provided additional prognostic information beyond the echocardiographically assessed severity of periAR and independently predicted 1-year mortality (hazard ratio: 2.9, 95% confidence interval: 1.3 to 6.4; p = 0.009). CONCLUSIONS: The assessment of the AR index allows a precise judgment of periAR, independently predicts 1-year mortality after TAVI, and provides additional prognostic information that is complementary to the echocardiographically assessed severity of periAR.

KI fragen

Bookmark

View Full Paper