Abstract 19512: Aortic Annulus Sphericity Index is Predictive of Significant Aortic Regurgitation After Transcatheter Aortic Valve Replacement
Introduction: Aortic regurgitation (AR) is a known occurrence post Transcatheter Aortic Valve Replacement (TAVR), and has significant impact on morbidity and mortality.
Hypothesis: We hypothesize that the degree of circularity of the aortic annulus on pre-TAVR computed tomography (CT) predicts development of post-TAVR moderate or severe AR.
Methods: In this observational, retrospective study, we reviewed data on 350 TAVR patients at our institution from 2012-2015. Using CT, aortic annulus measurements were collected to evaluate the size of the aortic annulus and calculate the Sphericity Index (SI). SI was calculated by dividing the long diameter of the aortic annulus by the short diameter of the aortic annulus. Post-TAVR Transthoracic Echocardiograms (TTEs) were used to determine degree of AR prior to discharge. Significant AR was defined as moderate or severe AR. A Receiver Operating Characteristic (ROC) curve was used to validate SI. We use Youdin Index (d2) to determine the optimal cutoff point of SI. All Analyses were done using SAS 9.4 ®.
Results: The 350 patients had a mean age of 83.3 ± 7.2 years, BMI was 27.3 ± 5.5 kg/m2, 46.6% were male, and 92.3% were non-Hispanic White. The mean SI was 1.26 ± 0.09. Using Youdin Index the optimal SI cutoff was 1.33 and corresponds to the 75th percentile of deviation from a circle. There were 5.5% of patients with an SI of 1.33 or less who developed significant AR post-TAVR. In contrast, 22.4% of patients with an SI above 1.33 developed significant AR post-TAVR (p < 0.001). Sensitivity was 53% and specificity was 81%.
Conclusion: Currently, there are no non-invasive pre-TAVR methods to predict development of significant AR post-TAVR. We have determined that the SI, used to measure the degree of circularity of the aortic annulus, is a non invasive measurement that can be used to predict the development of significant AR. SI measurements greater than 1.33 predict AR and provide more insight for pre-TAVR evaluation.
Author Disclosures: Z.J. Williams: None. G.A. Medranda: None. K. Brahmbhatt: None. A.M. Hafiz: None. R. Calixte: None. J. Gaztanaga: None. B. Ray: None. K. Marzo: None. R. Schwartz: None. S. Green: None.
- © 2015 by American Heart Association, Inc.