1
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Elzomor H, Neumann TJ, Boas L, Ruile P, Abdelshafy M, Elkoumy A, Revaiah PC, Tsai TY, Kaier K, Soliman O, Ferenc M, Westermann D, Neumann FJ, Serruys P, Schoechlin S. Association between three-year mortality after transcatheter aortic valve implantation and paravalvular regurgitation graded by videodensitometry in comparison with visual grading. Clin Res Cardiol 2024; 113:116-125. [PMID: 37553516 PMCID: PMC10808559 DOI: 10.1007/s00392-023-02280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiograms is a new tool for objective grading of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI). Stratification with boundaries at 6% and 17% has been proposed to reflect "none/trace", "mild" and "moderate or higher" PVR. OBJECTIVE We sought to investigate the association of strata of VD-AR with 3-year mortality and to compare VD-AR with visual grading of angiograms. METHODS We interrogated our database for patients undergoing transfemoral TAVI from 2008 to 2018. Vital status of the patients was obtained from population registers. To test differences in survival and estimate adjusted hazard ratios (HRs) we fitted Cox models. RESULTS Our retrospective study included 699 patients with evaluable angiograms at completion of the TAVI procedure. Cumulative 3-year mortality was 35.0% in 261 (37.3%) patients with VD-AR < 6%, 33.9% in 325 (46.5%) patients with VD-AR between 6 and 17% (HR [95% confidence interval] 1.06 [0.80-1.42]; P = 0.684) and 47.2% in 113 (16.2%) patients with VD-AR > 17% (HR 1.57 [1.11-2.22]; P = 0.011). Visually, PVR was graded as "none/trace" in 470 (67.2%) patients, as "mild" in 219 (31.3%) and as "moderate" in 10 (1.4%). Both mild PVR and moderate PVR on visual grading were significantly associated with mortality (HRs 1.31 [1.12-1.54]; P = 0.001 and 1.92 [1.13-3.24]; P = 0.015; respectively). CONCLUSIONS VD-AR > 17%, but not VD-AR 6-17%, was independently associated with mortality. Compared with subjective visual evaluation, VD-AR resulted in a smaller proportion of patients with PVR classified as prognostically relevant.
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Affiliation(s)
- Hesham Elzomor
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Timotheus J Neumann
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Linus Boas
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Ahmed Elkoumy
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Pruthvi C Revaiah
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Tsung-Ying Tsai
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University of Freiburg Medical Centre, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Osama Soliman
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Miroslaw Ferenc
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick Serruys
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Simon Schoechlin
- Department of Cardiology and Angiology, University of Freiburg Medical Centre, Südring 15, Bad Krozingen, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Elkoumy A, Jose J, Gunasekaran S, Kumar A, Srinivas BC, Manjunath CN, Ravindranath KS, Parekh M, Chandra P, Kapoor R, Abdelshafy M, Seth A, Agrawal P, Mathur A, Rao RS, Elzomor H, Sadanada KS, Kumar V, Arsang-Jang S, Mehrotra S, Raghuraman B, Khanolkar U, Premchand RK, Chopra M, Krishna P, Mehta H, Gupta R, Kumar V, Boopathy N, Baumbach A, Serruys PW, Soliman O. Angiographic quantification of aortic regurgitation following myval octacor implantation; independent core lab adjudication. Int J Cardiol 2023; 382:68-75. [PMID: 37028710 DOI: 10.1016/j.ijcard.2023.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND The balloon expandable Myval transcatheter heart valve (THV) showed encouraging results regarding residual aortic regurgitation (AR) from multiple observational studies. The newly designed Myval Octacor has been introduced recently, aiming for a reduction in AR and improved performance. OBJECTIVES The focus of this study is to report the incidence of AR using the validated quantitative Videodensitometry angiography technology (qLVOT-AR%) in the first in human use of the Myval Octacor THV system. METHODOLOGY We report on the first in human use of the Myval Octacor THV system in 125 patients in 18 Indian centres. Independent retrospective analysis of the final aortograms following implantation of the Myval Octacor was performed using the CAAS-A-Valve software. AR is reported as a regurgitation fraction. The previously validated cutoff values have been used to identify ≥moderate AR (RF% >17%), mild (6% < RF% ≤17%), and none or trace AR (RF% ≤ 6%). RESULTS Final aortogram was analysable for 103 patients (84.4%) among the 122 available aortograms. 64 (62%) patients, had tricuspid aortic valve (TAV), 38 (37%) with bicuspid AV (BAV), and one with unicuspid AV. The median absolute RF% was 2% [1, 6], moderate or more AR incidence was 1.9%, mild AR in 20.4%, and none or trace AR in 77.7%. The two cases with RF% >17% were in the BAV group. CONCLUSION The initial results of Myval Octacor using quantitative angiography-derived regurgitation fraction demonstrated a favourable outcome regarding residual AR, possibly due to improved device design. Results must be confirmed in a larger randomised study, including other imaging modalities.
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Affiliation(s)
- Ahmed Elkoumy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo 11651, Egypt
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore 632004, India
| | | | - Asish Kumar
- Department of Cardiology, Meitra Hospital, Calicut, Kerala 673005, India
| | - B C Srinivas
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
| | - K S Ravindranath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
| | - Maulik Parekh
- Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra 400004, India
| | | | | | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | | | - Atul Mathur
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | | | - Hesham Elzomor
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland
| | - K S Sadanada
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka 570016, India
| | - Vijay Kumar
- Madras Medical Mission Hospital, Chennai, Tamil Nadu 600037, India
| | - Shahram Arsang-Jang
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, H91 W2TY Galway, Ireland
| | - Sanjay Mehrotra
- Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka 560099, India
| | | | - Uday Khanolkar
- Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka 560099, India
| | | | - Manik Chopra
- Narayana Hospital (NH), Ahmedabad, Gujarat 380023, India
| | - Prem Krishna
- P S Govindaswami (PSG), Coimbatore 641004, India
| | - Haresh Mehta
- S. L. Raheja Hospital - Fortis, Mumbai, Maharashtra 400016, India
| | - Rahul Gupta
- Apollo Hospital, Navi Mumbai, Maharashtra 400614, India
| | - Viveka Kumar
- Max Hospital, Saket, New Delhi, Delhi 110017, India
| | | | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London EC1M 6BQ, UK
| | - Patrick W Serruys
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, H91 W2TY Galway, Ireland
| | - Osama Soliman
- Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, H91 W2TY Galway, Ireland.
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Kitamura M, Von Roeder M, Abdel-Wahab M. Quantitative assessment of aortic regurgitation following transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:633-645. [PMID: 33945360 DOI: 10.1080/14779072.2021.1924675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is expanding to lower risk and younger patients with severe symptomatic aortic valve disease. Despite clinical and technological improvements, post-procedural aortic regurgitation (AR) remains a limitation of TAVR, particularly when compared to surgical aortic valve replacement. Although several methods for AR quantification after TAVR are currently available, its exact graduation in everyday clinical practice remains challenging.Areas covered: This review describes the currently available evaluation methods of AR after TAVR, with a special emphasis on the quantitative assessment using videodensitometric angiography, echocardiography and cardiac magnetic resonance imaging.Expert opinion: In the majority of clinical scenarios, satisfactory evaluation of post-TAVR AR can be achieved with a combination of post-procedural angiography, hemodynamic indices and transthoracic echocardiography. Nevertheless, some TAVR patients show 'intermediate' forms of post-procedural AR, in which quantitative evaluation is mandatory for prognostic purposes and further decision-making. Notably, interpretation of quantitative measures early post-TAVR is challenging because of the lack of left ventricular enlargement. Video-densitometric angiography is an emerging method that appears to be clinically attractive for immediate post-TAVR assessment, but requires further validation in everyday clinical practice.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian Von Roeder
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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4
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Nara Y, Watanabe Y, Kataoka A, Nakashima M, Hioki H, Kawashima H, Nagura F, Kozuma K, Yashima F, Shirai S, Tada N, Yamawaki M, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Yamamoto M, Hayashida K. Balloon post-dilatation improves long-term valve performance after balloon-expandable valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:15-22. [PMID: 34175251 DOI: 10.1016/j.carrev.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of balloon post-dilatation (BPD) on short- and long-term valve performance after Sapien 3 (S3) implantation is unknown. This study aimed to evaluate the impact of balloon post-dilatation (BPD) on short- and long-term valve performance after the implantation of S3. METHODS A total of 846 patients implanted with S3 from the OCEAN-TAVI registry were included in this study. The patients were divided into BPD and non-BPD groups. The clinical outcomes and valve functions were compared. RESULTS The BPD group included 173 (20.4%) patients and the non-BPD group comprised 673 (79.6%) patients. The prosthesis-patient mismatch (PPM) rates were significantly lower in the BPD group than in the non-BPD group before and after propensity score matching at in-hospital follow-up (before matching: 12 [7.1%] vs. 108 [16.3%], p = 0.002; after matching: 8 [6.3%] vs. 19 [14.8%], p = 0.027) and at 1-year follow-up (before matching: 14 [12.5%] vs. 112 [23.6%], p = 0.010; after matching: 9 [10.5%] vs. 19 [22.1%], p = 0.039). The rates of acute kidney injury, cardiac tamponade, and in-hospital cardiovascular death were significantly higher in the BPD group than in the non-BPD group (acute kidney injury: 22 [12.7%] vs. 33 [4.9%], p < 0.001; cardiac tamponade: 3 [1.7%] vs. 2 [0.3%], p = 0.028; in-hospital cardiovascular death: 4 [2.3%] vs. 3 [0.4%], p = 0.016). After matching, these clinical outcomes were similar between the BPD and non-BPD groups. CONCLUSIONS The BPD group demonstrated better short- and long-term valve performance. Caution is needed to avoid procedure-related complications in patients undergoing BPD.
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Affiliation(s)
- Yugo Nara
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan.
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Makoto Nakashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fukuko Nagura
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Norio Tada
- Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine, Toyohashi Heart Center and Nagoya Heart Center, Aichi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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5
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Modolo R, Chang CC, Onuma Y, Schultz C, Tateishi H, Abdelghani M, Miyazaki Y, Aben JP, Rutten MC, Pighi M, El Bouziani A, van Mourik M, Lemos PA, Wykrzykowska JJ, Brito FS, Sahyoun C, Piazza N, Eltchaninoff H, Soliman O, Abdel-Wahab M, Van Mieghem NM, de Winter RJ, Serruys PW. Quantitative aortography assessment of aortic regurgitation. EUROINTERVENTION 2020; 16:e738-e756. [DOI: 10.4244/eij-d-19-00879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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6
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Modolo R, Chang CC, Tateishi H, Miyazaki Y, Pighi M, Abdelghani M, Roos MA, Wolff Q, Wykrzykowska JJ, de Winter RJ, Piazza N, Richardt G, Abdel-Wahab M, Soliman OI, Onuma Y, Van Mieghem NM, Serruys PW. Quantitative aortography for assessing aortic regurgitation after transcatheter aortic valve implantation: results of the multicentre ASSESS-REGURGE Registry. EUROINTERVENTION 2019; 15:420-426. [DOI: 10.4244/eij-d-19-00362] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Modolo R, Miyazaki Y, Chang CC, Te Lintel Hekkert M, van Sloun M, Suchecki T, Aben JP, Soliman OI, Onuma Y, Duncker DJ, van Mieghem NM, Serruys PW. Feasibility study of a synchronized diastolic injection with low contrast volume for proper quantitative assessment of aortic regurgitation in porcine models. Catheter Cardiovasc Interv 2018; 93:963-970. [PMID: 30430723 DOI: 10.1002/ccd.27972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the in vivo feasibility of aortography with one accurately timed diastolic low-volume contrast injection for quantitative assessment of aortic regurgitation (AR) post transcatheter aortic valve replacement (TAVR). BACKGROUND With the rise of a minimalistic approach for TAVR, aortography (re)emerges as a pragmatic tool for AR assessment. In a mock circulation system, we have validated the accuracy of a single diastolic injection triggered by electrocardiogram (ECG) with low-contrast volume. METHODS Two-phase experiment: first, a series of aortograms were performed in a porcine model, with 8 mL of contrast using the synchronized (SYNC) and the conventional non-synchronized (NS) injections. In a second phase, we developed a model of AR by inserting partially unsheathed Wallstents of 6-10 mm of diameter across the pig's aortic valve, performing SYNC injections with 8 mL of contrast and NS injections with 8 mL and 15 mL (rate: 20 mL/sec). Respective accuracies of SYNC vs. NS were assessed using Passing-Bablock regression. An angiography core laboratory performed quantitative AR assessment with videodensitometry (VD-AR). RESULTS The SYNC injections produced higher opacification of the aortic root compared with NS injections (P = 0.04 for density). In the second phase, a regression line for predicting VD-AR based on the SYNC injection resulted in a lower intercept and a slope closer to the line of identity (y = 11.9 + 0.79x, P < 0.001, r2 = 0.94) with the NS-8 mL than with the NS-15 mL injection (y = 26.5 + 0.55x, P < 0.001, r2 = 0.81). CONCLUSION Synchronized diastolic injection with low contrast volume produced denser images in the aortic root and more accurate than the conventional injection; thus, may be an appealing alternative for assessment of AR post TAVR.
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Affiliation(s)
- Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Yosuke Miyazaki
- Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Chun Chin Chang
- Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maaike Te Lintel Hekkert
- Department of Cardiology, Division of Experimental Cardiology, Thoraxcenter, Cardiovascular Research School COEUR, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Osama I Soliman
- Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.,Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, The Netherlands
| | - Yoshinobu Onuma
- Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.,Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Division of Experimental Cardiology, Thoraxcenter, Cardiovascular Research School COEUR, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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8
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Miyazaki Y, Modolo R, Abdelghani M, Tateishi H, Cavalcante R, Collet C, Asano T, Katagiri Y, Tenekecioglu E, Sarmento-Leite R, Mangione JA, Abizaid A, Soliman OII, Onuma Y, Serruys PW, Lemos PA, Brito FSD. The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation. Arq Bras Cardiol 2018; 111:193-202. [PMID: 30183986 PMCID: PMC6122904 DOI: 10.5935/abc.20180139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/07/2018] [Indexed: 12/26/2022] Open
Abstract
Background Balloon post-dilatation (BPD) is often needed for optimizing transcatheter
heart valve (THV) implantation, since paravalvular leak (PVL) after
transcatheter aortic valve implantation is associated with poor outcome and
mortality. Quantitative assessment of PVL severity before and after BPD is
mandatory to properly assess PVL, thus improving implantation results and
outcomes. Objective To investigate a quantitative angiographic assessment of aortic regurgitation
(AR) by videodensitometry before and after BPD. Methods Videodensitometric-AR assessments (VD-AR) before and after BPD were analysed
in 61 cases. Results VD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p
< 0.001, a two-tailed p < 0.05 defined the statistical significance).
The relative delta of VD-AR after BPD ranged from -100% (improvement) to
+40% (deterioration) and its median value was -46.2%. The frequency of
improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15)
and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed
in 47 patients (77%) before and in 19 patients (31%) after BPD. Conclusions VD-AR after THV implantation provides a quantitative assessment of post-TAVI
regurgitation and can help in the decision-making process on performing BPD
and in determining its efficacy.
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Affiliation(s)
- Yosuke Miyazaki
- Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam - Netherlands
| | - Rodrigo Modolo
- Department of Cardiology - the Academic Medical Center - University of Amsterdam, Amsterdam - Netherlands.,Departamento de Medicina Interna - Divisão de Cardiologia - Universidade de Campinas (UNICAMP), Campinas, SP - Brazil
| | - Mohammad Abdelghani
- Department of Cardiology - the Academic Medical Center - University of Amsterdam, Amsterdam - Netherlands
| | - Hiroki Tateishi
- Division of Cardiology - Department of Clinical science and Medicine - Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi - Japan
| | - Rafael Cavalcante
- Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam - Netherlands
| | - Carlos Collet
- Department of Cardiology - the Academic Medical Center - University of Amsterdam, Amsterdam - Netherlands
| | - Taku Asano
- Department of Cardiology - the Academic Medical Center - University of Amsterdam, Amsterdam - Netherlands
| | - Yuki Katagiri
- Department of Cardiology - the Academic Medical Center - University of Amsterdam, Amsterdam - Netherlands
| | - Erhan Tenekecioglu
- Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam - Netherlands
| | - Rogério Sarmento-Leite
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia e Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brazil
| | - José A Mangione
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Osama I I Soliman
- Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam - Netherlands.,Cardialysis, Rotterdam - Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam - Netherlands.,Cardialysis, Rotterdam - Netherlands
| | | | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Fabio S de Brito
- Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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Tateishi H, Miyazaki Y, Okamura T, Abdelghani M, Modolo R, Wada Y, Okuda S, Omuro A, Ariyoshi T, Fujii A, Oda T, Fujimura T, Nanno T, Mikamo A, Soliman OI, Onuma Y, Hamano K, Yano M, Serruys PW. Inter-Technique Consistency and Prognostic Value of Intra-Procedural Angiographic and Echocardiographic Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Implantation. Circ J 2018; 82:2317-2325. [DOI: 10.1253/circj.cj-17-1376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroki Tateishi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | | | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | | | | | - Yasuaki Wada
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Shinichi Okuda
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Ayumi Omuro
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Toru Ariyoshi
- Ultrasound Examination Center, Yamaguchi University Hospital
| | - Ayano Fujii
- Division of Laboratory, Yamaguchi University Hospital
| | - Tetsuro Oda
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Takuma Nanno
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Akihito Mikamo
- Division of Surgery, Department of Clinical Science of Surgery, Yamaguchi University Graduate School of Medicine
| | | | | | - Kimikazu Hamano
- Division of Surgery, Department of Clinical Science of Surgery, Yamaguchi University Graduate School of Medicine
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Patrick W. Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London
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10
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Miyazaki Y, Abdelghani M, de Boer ES, Aben JP, van Sloun M, Suchecki T, van 't Veer M, Collet C, Asano T, Katagiri Y, Tenekecioglu E, Soliman OII, Onuma Y, de Winter R, Tonino P, van de Vosse FN, Rutten MCM, Serruys PW. A novel synchronised diastolic injection method to reduce contrast volume during aortography for aortic regurgitation assessment: in vitro experiment of a transcatheter heart valve model. EUROINTERVENTION 2018; 13:1288-1295. [PMID: 28691911 DOI: 10.4244/eij-d-17-00355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In the minimalist transcatheter aortic valve implantation (TAVI) era, the usage of transoesophageal echocardiography has become restricted. Conversely, aortography has gained clinical ground in quantifying prosthetic valve regurgitation (PVR) during the procedure. In a mock circulation system, we sought to compare the contrast volume required and the accuracy of aortographic videodensitometric PVR assessment using a synchronised diastolic and standard (non-synchronised) injection aortography. METHODS AND RESULTS Synchronised diastolic injection triggered by the signal stemming from the mock circulation was compared with standard non-synchronised injection. A transcatheter heart valve was implanted and was deformed step by step by advancing a screw perpendicularly to the cage of the valve in order to create increasing PVR. Quantitative measurement of PVR was derived from time-density curves of both a reference area (aortic root) and a region of interest (left ventricle) developed by a videodensitometric software. The volume of contrast required for the synchronised diastolic injection was significantly less than in the non-synchronised injection (8.1 [7.9-8.5] ml vs. 19.4 [19.2-19.9] ml, p<0.001). The correlation between the two methods was substantial (Spearman's coefficient rho ranging from 0.991 to 0.968). Intraobserver intra-class correlation coefficient for both methods of injection was 0.999 (95% CI: 0.996-1.000) for the synchronised diastolic and 0.999 (95% CI: 0.996-1.000) for the non-synchronised injection group. The mean difference in the rating was 0.17% and limits of agreement were ±1.64% for both groups. CONCLUSIONS A short synchronised diastolic injection enables contrast volume reduction during aortography without compromising the accuracy of the quantitative assessment of PVR using videodensitometry.
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Affiliation(s)
- Yosuke Miyazaki
- Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Tateishi H, Miyazaki Y, Okamura T, Modolo R, Abdelghani M, Soliman OI, Oda T, Mikamo A, Onuma Y, Hamano K, Yano M, Serruys PW. Role of Computed Tomography in Planning the Appropriate X-Ray Gantry for Quantitative Aortography of Post-transcatheter Aortic Valve Implantation Regurgitation. Circ J 2018; 82:1943-1950. [DOI: 10.1253/circj.cj-17-1375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroki Tateishi
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine
| | | | - Takayuki Okamura
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Centre
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP)
| | | | | | - Tetsuro Oda
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine
| | - Akihito Mikamo
- Division of Surgery, Department of Clinical Science of Surgery, Yamaguchi University Graduate School of Medicine
| | - Yoshinobu Onuma
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine
- Cardialysis
| | - Kimikazu Hamano
- Division of Surgery, Department of Clinical Science of Surgery, Yamaguchi University Graduate School of Medicine
| | - Masafumi Yano
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine
| | - Patrick W. Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London
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12
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A Novel Angiographic Quantification of Aortic Regurgitation After TAVR Provides an Accurate Estimation of Regurgitation Fraction Derived From Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Interv 2018; 11:287-297. [DOI: 10.1016/j.jcin.2017.08.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
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13
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Abdelghani M, Miyazaki Y, de Boer E, Aben JP, van Sloun M, Suchecki T, van 't Veer M, Soliman O, Onuma Y, de Winter R, Tonino P, van de Vosse F, Rutten M, Serruys P. Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation. EUROINTERVENTION 2018; 13:1527-1535. [DOI: 10.4244/eij-d-17-00595] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Miyazaki Y, Soliman O, Abdelghani M, Katsikis A, Naz C, Lopes S, Warnack B, Cox M, Onuma Y, Serruys P. Acute performance of a novel restorative transcatheter aortic valve: preclinical results. EUROINTERVENTION 2017; 13:e1410-e1417. [DOI: 10.4244/eij-d-17-00554] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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