Assessment of paravalvular regurgitation after transcatheter aortic valve replacement using 2D multi-venc and 4D flow CMR.

Abstract

To compare the novel 2D multi-venc and 4D flow acquisitions with the standard 2D flow acquisition for the assessment of paravalvular regurgitation (PVR) after TAVR using cardiac magnetic resonance (CMR)-derived regurgitant fraction (RF). In this prospective study, patients underwent CMR one month after TAVR to assess PVR using 2D multi-venc and 4D flow, in addition to standard 2D flow. Scatterplots and Bland-Altman plots were used to assess correlation and visualize agreement between techniques. Reproducibility of measurements was assessed with intraclass correlation coefficients. The study included 21 patients (mean age, 80 years ± 5 [SD], 9 men). Mean RF was 11.7 ± 10.0% using standard 2D flow, 10.6 ± 7.0% using 2D multi-venc flow, and 9.6 ± 7.3% using 4D flow. There was a very strong correlation between the RFs assessed with 2D multi-venc and standard 2D flow (r = 0.88, p < 0.001), and a strong correlation between the RFs assessed with 4D flow and standard 2D flow (r = 0.74, p < 0.001). Bland-Altman plots revealed no significant bias between the RFs (2D multi-venc: 1.3%; 4D flow: 0.3%). Intra- and interobserver reproducibility for 2D multi-venc flow were 0.98 and 0.97, respectively; and 0.92 and 0.90 for 4D flow, respectively. 2D multi-venc and 4D flow produce accurate quantification of PVR after TAVR. The fast acquisition of the 2D multi-venc sequence, and the free-breathing acquisition with retrospective plane selection of the 4D flow sequence provide useful advantages in clinical practice, especially in the frail TAVR population.