Cardiologia Clínica e Experimental
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Multiparametric Assessment of Post-Transcatheter Aortic Valve Repacement Paravalvular Regurgitation Grading by Transthoracic Echocardiography and Cardiac Magnetic Resonance

Salim Hayek, Fadi Sawaya, John Oshinski and Stamatios Lerakis

Purpose: Paravalvular regurgitation post-transcatheter valve replacement is associated with poor outcomes. The Valve Academic Research Consortium has defined qualitative and quantitative criteria for assessing paravalvular leak severity by transthoracic echocardiography. Cardiac magnetic resonance imaging is highly accurate and reproducible in measuring aortic flow volumes, and has been used for further evaluation of paravalvular regurgitation. The agreement between the multiparametric grading of paravalvular regurgitation by transthoracic echocardiography and cardiac magnetic resonance imaging is unclear.

Methods: We retrospectively identified 18 patients who had undergone transcatheter aortic valve replacement and received both transthoracic echocardiography and cardiac magnetic resonance imaging. The following echocardiographic parameters were measured: regurgitant fraction, effective regurgitant orifice area, jet width diameter, circumferential extent of paravalvular leak. Regurgitant fraction was measured on cardiac magnetic resonance imaging using the phase-contrast technique. Paravalvular leak was graded according to the VARC-2 guidelines. A total of 21 paired imaging studies were compared.

Results: The interparametric agreement was poor, with a kappa statistic ranging between -0.02 to 0.21. Most notably, severity by echocardiographic circumferential extent was over-estimated in 85.7% of studies compared to cardiac magnetic resonance imaging.

Conclusions: The agreement between the different echocardiographic parameters, and between echocardiography and cardiac magnetic resonance in assessing paravalvular leak severity is poor. Cardiac magnetic resonance imaging should be considered in the evaluation of paravalvular severity when the echocardiographic assessment and clinical findings are incongruent. Larger, prospective studies comparing both modalities are needed to justify its routine use in the evaluation of paravalvular regurgitation post-transcatheter aortic valve replacement.