Author + information
- Garrett B. Wong,
- Jeffrey Southard,
- Jason Rogers,
- Thomas Smith,
- Ehrin Armstrong,
- Jeffrey Levisman,
- Mona Flores,
- Douglas Boyd and
- Reginald Low
One of the limitations of transcatheter aortic valve replacement (TAVR) is perivalvular aortic regurgitation (periAR). Greater degrees of periAR negatively impact outcomes. The AR index has been proposed as an echocardiographically independent method of quantifying periAR, with a post–TAVR AR index < 25 associated with increased mortality. We sought to evaluate the effects of heart rate (HR) on the AR index
After Edwards Sapien implantation, we measured post–TAVR AR index [(DBP–LVEDP)/SBP] x100 in a consecutive, ongoing series of patients. Simultaneous LV–Aortic pressures were obtained, and the AR index was calculated at the patient's native HR, 70 bpm, and 90 bpm achieved by temporary atrial pacing.
Data on 14 subjects are available in this ongoing investigation. Post–TAVR AR was graded as mild (≤2+) by echocardiography in all subjects. The mean LVEDP at baseline HR was 28 mmHg, at HR 70 was 23.4 mmHg, and at HR 90 was 21.9 mmHg. The mean AR index at baseline HR was 18.9, at HR 70 was 23.8, and at HR 90 was 29.9. The AR index increased by an average of 11 with the increased HR, surpassing the threshold of < 25, which has been linked to increased 1 year mortality.
The AR index is HR dependent, and becomes less significant at increasing heart rates. This may have important implications for clinical utility of the AR index, and the value should be integrated with the patient's HR at the time of assessment. Full results will be presented.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–230
- 2013 American College of Cardiology Foundation