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Aortic regurgitation as quantified by CMR predicts outcomes after TAVR
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Worse cardiac magnetic resonance-quantified aortic regurgitation was associated with higher mortality and poorer clinical results after transcatheter aortic valve replacement, according to a study published in the Journal of the American College of Cardiology.
Henrique B. Ribeiro, MD , PhD, from Quebec Heart and Lung Institute, Laval University, Quebec City, and colleagues analyzed 135 patients who underwent TAVR because of severe symptomatic aortic stenosis.
Henrique B. Ribeiro
Aortic regurgitation was gauged by using regurgitant fraction and was measured by two factors: phase-contrast velocity mapping cardiac magnetic resonance (CMR) at a median of 40 days post-TAVR and Doppler echocardiography at a median of 6 days after TAVR.
The median follow-up was 26 months. Outcomes of interest included mortality and rehospitalization for HF.
The researchers found that moderate-to-severe aortic regurgitation occurred in 17.1% of patients measured by echocardiography and in 12.8% of those evaluated via CMR.
According to the researchers, a higher regurgitant fraction after TAVR was linked to raised mortality (HR for each 5% increase in regurgitant fraction = 1.18; 95% CI, 1.08-1.3), as well as the combined endpoint and mortality and re-hospitalization for HF (HR for each 5% increase in regurgitant fraction = 1.19; 95% CI, 1.15-1.23).
CMR administered a median of 40 days after TAVR showed a greater link to post-TAVR clinical outcomes vs. early echocardiography (P < .01), Ribiero and colleagues wrote.
Poorer clinical outcomes for mortality or the combination of HF re-hospitalization and mortality were best predicted by regurgitant fraction of at least 30% (P < .001 for both), the researchers wrote.
“Prior studies in the TAVR field have consistently shown the negative clinical effect of significant [aortic regurgitation] after TAVR as evaluated by [transthoracic echocardiography]. ... [Our] study confirmed that CMR performed at a median of 40 days post-TAVR may improve the prediction of poorer clinical outcomes,” Ribiero and colleagues wrote. “There appears to be a stepwise increase in clinical events including mortality and re-hospitalization for [HF] according to the differing grades of regurgitant fraction post-TAVR.” – by James Clark
Disclosure: Ribeiro reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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