Abstract 13496: Aortic Regurgitation Index Defines Severity of Periprosthetic Regurgitation and Predicts Outcome in Patients after Tavi: A Two-Centre Experience
Background: More-than-mild peri-prosthetic aortic regurgitation (periAR) after TAVI is associated with adverse outcome. We hypothesized that periprocedural measurement of hemodynamic parameters allows reproducible and point-of-care assessment of periAR and predicts long-term outcome.
Methods and Results: The severity of periAR was evaluated in 268 TAVI patients of two independent high-volume TAVI centers (development cohort: N=146; validation cohort: N=122) by echocardiography, angiography, and periprocedural measurement of the ratio of the gradient between diastolic blood pressure (DBP) in the aorta and left-ventricular end-diastolic pressure (LVEDP) to the systolic blood pressure (SBP) in the aorta, the so-called aortic regurgitation index (AR index) = [(DBP-LVEDP)/SBP] x 100. In the overall cohort, 80/268 (29.9%) showed no periAR, 146/268 (54.5%) mild periAR, 36/268 (13.4%) moderate periAR, and 6/268 (2.2%) suffered from severe periAR after TAVI. In the development cohort, 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). This association was confirmed in the validation cohort (p<0.001). Patients with AR index <25 had a significantly increased 1-year mortality rate compared to patients with AR index ≥25 (46.0% vs. 16.7%; p<0.001), as assessed in the development cohort, and as reproduced in the independent validation cohort (42.3% vs. 14.3%; p<0.001). The AR index provided prognostic information beyond the echocardiographically assessed severity of periAR and independently predicted 1-year mortality in both TAVI cohorts.
Conclusions: The AR index is strongly associated with the severity of periAR and independently predicts 1-year mortality after TAVI. It provides prognostic information that is complementary to the degree of periAR and can be used to guide periprocedural clinical decisions.
- © 2012 by American Heart Association, Inc.