CMR quantitation of change in mitral regurgitation following transcatheter aortic valve replacement (TAVR): impact on left ventricular reverse remodeling and outcome

Chew, Pei G.; Dobson, Laura E; Garg, Pankaj; Fairbairn, Timothy A.; Musa, Tarique A; Uddin, Akhlaque; Swoboda, Peter; Foley, James Rj; Fent, Graham; Brown, Louise A.; Onciul, Sebastian; Plein, Sven; Blackman, Daniel J.; Greenwood, John P.

doi:10.1007/s10554-018-1441-y

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…Recently, multi-modality imaging, i.e. conventional CT combined with cardiac magnetic resonance, has demonstrated useful for pre 43 and post-TAVI evaluation, especially to quantify residual aortic regurgitation 44 .…”

Section: Discussionmentioning

confidence: 99%

A validated computational framework to predict outcomes in TAVI

Bosi

Capelli

Cheang

et al. 2020

Sci Rep

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transcatheter aortic valve implantation (tAVi) still presents complications: paravalvular leakage (pVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14 SapienXT and 14 CoreValve) were retrospectively selected. Pre-procedural CT images were post-processed to create 3D patientspecific implantation sites. The procedures were simulated with finite element analysis. Simulations' results were compared against post-procedural clinical fluoroscopy and echocardiography images. The computational model was in good agreement with clinical findings: the overall stent diameter difference was 2.6% and PVL was correctly identified with a post-processing algorithm in 83% of cases. Strains in the implantation site were studied to assess the risk of conduction system disturbance and were found highest in the patient who required pacemaker implantation. this study suggests that computational tool could support safe planning and broadening of tAVi. Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with severe aortic stenosis (AS) who are deemed unsuitable for surgery 1-5. Since the first-in-man implantation in 2002 6 , TAVI technology has experienced a tremendous amount and pace of progress, thanks to developments in pre-procedural imaging assessment, operator experience, and engineering device research 7 , so that a treatment that was designed for high-risk patients only, is now shifting toward lower surgical risk case applications 8,9 with many companies presenting innovative valved stent designs to overcome most of the limitations of the first-generation TAVI devices 5,7,10. However, TAVI still presents complications, mainly related to device sizing and positioning. If oversized, the TAVI device might cause vascular injury, such as aortic dissection, perforation or rupture of the aortic annulus; 11,12 if undersized, it may present anchoring problems, embolization and paravalvular leakage (PVL), reported in 65-89% of cases 13,14. Conduction abnormalities commonly (12-35%) occur following TAVI 15-18 , leading to the need of permanent pacemaker (PPM) implantation, more frequently required with self-expandable devices (28% vs. 6% of balloon-expandable choices) 19 likely due to their material properties and larger sizes resulting in higher forces applied to the adjacent native conduction system 1,18,20. These complications highlight the importance of accurate interventional planning, appropriate device choice and correct patient selection. In this context, computational simulations, an already established tool to support engineering device development, could be useful, if integrated with a patient-specific approach, to support clinical decision making and introduce new technologies in clinical practice. Despite increasing acknowledgement of the usefulness of patient-specific computational modelling from...

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Section: Discussionmentioning

confidence: 99%

A validated computational framework to predict outcomes in TAVI

Bosi

Capelli

Cheang

et al. 2020

Sci Rep

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“… 8 30 Thus, in this context, the indirect method may result in underestimation of possible mitral regurgitations, which is often coexisting with aortic stenosis. 30 …”

Section: Discussionmentioning

confidence: 99%

“…8 30 Thus, in this context, the indirect method may result in underestimation of possible mitral regurgitations, which is often coexisting with aortic stenosis. 30 The indirect method furthermore relies on the volumetric assessment as reference. Despite being the gold standard, 18 this method has several limitations.…”

Section: Mitral Regurgitation Assessments With the Indirect Methodsmentioning

confidence: 99%

Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method

et al. 2020

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ObjectiveCardiac MRI is quickly emerging as the gold standard for assessment of mitral regurgitation, most commonly with the indirect method subtracting forward flow in aorta from volumetric segmentation of the left ventricle. We aimed to investigate how aortic flow measurements with increasing distance from the aortic valve affect calculated mitral regurgitations and whether measurements were influenced by breath-hold regimen.MethodsFree-breathing and breath-hold phase contrast flows were measured in aorta at valve level, sinotubular (ST) junction, mid-ascending aorta and in the pulmonary trunk. Flow measurements were pairwise compared, and subsequently, after exclusion of patients with visible mitral and tricuspid regurgitations for left-sided and right-sided comparisons, respectively, flow-measured stroke volumes were compared with ventricular volumetric segmentations.ResultsThirty-nine participants without arrhythmias or structural abnormalities of the large vessels were included. Stroke volumes measured with free-breathing and breath-hold flow decreased equally with increasing distance to the aortic valves (breath-hold flow: aortic valve 105.6±20.8 mL, ST junction 101.5±20.7 mL, mid-ascending aorta 98.1±21.5 mL). After exclusion of atrioventricular regurgitations, stroke volumes determined by volumetric measurements were higher compared with values determined by flow measurements, corresponding to ‘false’ atrioventricular regurgitations of 8.0%±5.8% with flow measured at valve level, 11.6%±5.2% at the ST junction and 15.3%±5.0% at the mid-ascending aorta.ConclusionsStroke volumes determined by flow decrease throughout the proximal aorta and are systematically lower than volumetrically measured stroke volumes. The indirect method systematically overestimates mitral regurgitations, especially with increasing distance from the aortic valves.

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“…In a study of patients with ischemic mitral regurgitation, right ventricular (RV) dysfunction was associated with greater mitral regurgitation, lower LV EF, larger global ischemic burden and infarct size [57]. Chew et al found that mitral regurgitation improves in the majority of their patients following transcatheter aortic valve replacement [58]. Intrathoracic fat volume was found to be associated with contractile dysfunction in patients with coronary artery disease [59].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%