Hemodynamic Assessment of AorticRegurgitation After TranscatheterAortic Valve Replacement: The Diastolic Pressure-Time Index.

Abstract

Assessment of aortic regurgitation (AR) immediately after transcatheter aortic valve replacement (TAVR) is essential to guide further intervention in cases of relevant AR. It was the aim of this study to identify a simple and reproducible hemodynamic parameter for the assessment of AR. Relevant AR after TAVR is present in up to 21% of cases and might be associated with adverse long-term outcomes. Three hundred sixty-two consecutive patients who were treated with TAVR for symptomatic aortic valve stenosis were analyzed. AR was assessed by aortic root angiography according to the Sellers classification. For hemodynamic evaluation, the diastolic pressure-time (DPT) index was calculated after TAVR: the area between the aortic and left ventricular pressure-time curves was measured during diastole and divided by the duration of diastole to calculate the DPT index. The DPT index was finally adjusted for the respective systolic blood pressure: DPTindexadj=(DPT index/systolic blood pressure)×100. Patients with angiographically nonrelevant AR (grade<2) had higher DPT indexadj (30.7 ± 6.8) compared with those with relevant AR (grade≥2) (26.2 ± 5.8) (p< 0.05). Patients with DPT indexadj≤27.9 had significantly higher 1-year mortality risk in comparison with those with DPT indexadj >27.9: 41.4% versus 13.5% (hazard ratio: 3.8; 95% confidence interval: 2.4 to 5.9; p [log rank-test]< 0.001). In multivariate regression analysis, DPT indexadj≤27.9 was the strongest independent predictor of 1-year mortality (hazard ratio: 2.5; 95% confidence interval: 1.8 to 3.7; p< 0.001). DPT indexadj is a simple, investigator-independent parameter that should be considered to differentiatebetween relevant and nonrelevant AR after TAVR.