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Paravalvular aortic regurgitation (AR) after transcatheter aortic valve replacement(TAVR) has been associated with increased mortality. The aim of this study is to examine the previously described AR index and determine whether any modification to this index can improve its performance.
The study included 64 patients treated with the Sapien valve (Edwards Life Sciences, Inc., Irvine, CA). The severity of AR was evaluated using echocardiography, angiography, and invasive hemodynamic parameters. We evaluated time integrated aortic regurgitation (TIAR) index as follows: (LV-Ao diastolic pressure time integral) / (LV systolic pressure time integral)x100. We analyzed AR index and TIAR index with receiver operating characteristic (ROC) curve.
AR was observed in 58 patients (90.7%) and graded as mild in 33 (51.6%), moderate in 20 (31.3%) or moderate-to-severe in 5 (7.8%) cases. AR index and TIAR index decreased proportionate to increase severity of AR (p=0.002, p<0.001, respectively)(Table 1). TIAR index > 80 was associated with sensitivity of 86% and specivicity of 83% for ≥ mild AR. Area under curve was greater for TIAR index compare to AR index (0.93 versus 0.74) (Figure 1).
|All patients (N=64)||No AR (n=6)||Mild AR (n=33)||Moderate AR (n=20)||Moderate to Severe AR (n=5)||p value|
AR; Aortic Regurgitation, TIAR; Time İntegrated Aortic Regurgitation.
The TIAR index provides a useful hemodynamic measure for assessing severity of AR which is better than AR index.