Universität zu Köln

Altiok, Ertunc, Frick, Michael, Meyer, Christian G., Al Ateah, Ghazi, Napp, Andreas, Kirschfink, Annemarie, Almalla, Mohammad, Lotfi, Shahran, Becker, Michael, Herich, Lena, Lehmacher, Walter and Hoffmann, Rainer (2014). Comparison of Two- and Three-Dimensional Transthoracic Echocardiography to Cardiac Magnetic Resonance Imaging for Assessment of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation. Am. J. Cardiol., 113 (11). S. 1859 - 1867. BRIDGEWATER: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. ISSN 1879-1913

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Abstract

This study evaluated 2-dimensional (2D) transthoracic echocardiography (TTE) using Valve Academic Research Consortium-2 (VARC-2) criteria and 3-dimensional (3D) TTE for assessment of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) in comparison with cardiac magnetic resonance (CMR) imaging. In 71 patients, 2D TTE, 3D TTE, and CMR imaging were performed to assess AR severity after TAVI. Using 2D TTE, AR severity was graded according to VARC-2 criteria and regurgitant volume (RVol) was determined. Three-dimensional color Doppler TTE allowed direct planimetry of the vena contracta area of the paravalvular regurgitation jet and calculation of the RVol as product with the velocity-time integral. RVol by CMR imaging was measured by phase-contrast velocity mapping in the ascending aorta. After TAVI, mean RVol determined by CMR. imaging was 9.2 +/- 9.6 ml/beat and mean regurgitant fraction was 13.3 +/- 10.3%. AR was assessed as none or mild in 58 patients (82%) by CMR imaging. Correlation of 3D TTE and CMR imaging on RVol was better than correlation of 2D TTE and CMR imaging (r = 0.895 vs 0.558, p <0.001). There was good agreement between RVol by CMR imaging and by 3D TTE (mean bias = 2.4 ml/beat). Kappa on grading of AR severity was 0.357 between VARC-2 and CMR imaging versus 0.446 between 3D TTE and CMR imaging. Infraobserver variability for analysis of RVol of AR after TAVI was 73.5 +/- 52.2% by 2D TTE, 16.7 +/- 21.9% by 3D TTE, and 2.2 +/- 2.0% by CMR imaging. In conclusion, 2D TTE considering VARC-2 criteria has limitations in the grading of AR severity after TAVI when CMR imaging is used for comparison. Three-dimensional TTE allows quantification of AR with greater accuracy than 2D TTE. Observer variability on RVol after TAVI is considerable using 2D TTE, significantly less using 3D TTE, and very low using CMR imaging. (C) 2014 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Altiok, Ertunc UNSPECIFIED UNSPECIFIED UNSPECIFIED Frick, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Christian G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Al Ateah, Ghazi UNSPECIFIED UNSPECIFIED UNSPECIFIED Napp, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kirschfink, Annemarie UNSPECIFIED UNSPECIFIED UNSPECIFIED Almalla, Mohammad UNSPECIFIED UNSPECIFIED UNSPECIFIED Lotfi, Shahran UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Herich, Lena UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehmacher, Walter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-436895
DOI:	10.1016/j.amjcard.2014.02.038
Journal or Publication Title:	Am. J. Cardiol.
Volume:	113
Number:	11
Page Range:	S. 1859 - 1867
Date:	2014
Publisher:	EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Place of Publication:	BRIDGEWATER
ISSN:	1879-1913
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OF-CARDIOLOGY FOUNDATION; END-POINT DEFINITIONS; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; DOPPLER-ECHOCARDIOGRAPHY; CONSENSUS DOCUMENT; AMERICAN-SOCIETY; VENA CONTRACTA; SEVERITY; STENOSIS; RECOMMENDATIONS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43689