- Oral presentation
- Open Access
CMR to stratify post-TAVR paravalvular leak in patients with suboptimal echocardiography
© Hartlage et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Cardiovascular Magnetic Resonance
- NYHA Class
- Transcatheter Aortic Valve Replacement
- Aortic Valve Calcification
- Paravalvular Leak
Despite extensive pre-procedure evaluation, greater than mild paravalvular leak (PVL) occurs in over 10% of patients undergoing transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes. Echocardiography, the standard method of imaging PVL, often has limited utility due to frequently multiple eccentric regurgitant jets. Acoustic shadowing from the valve stent and native aortic valve calcification may lead to further underestimation of PVL. Cardiovascular magnetic resonance (CMR) is considered the gold standard for quantification of valvular regurgitation. We evaluated the utility of CMR to grade PVL severity and predict outcomes in patients with suboptimal echocardiography.
Seventeen non-operative post-TAVR patients (NYHA class III-IV; age 84 ± 5 yrs) underwent CMR due to PVL and symptoms out of proportion to echocardiographic findings or suboptimal echocardiographic study. CMR was performed on a Siemens Avanto 1.5 T with velocity phase imaging in the ascending aorta for flow quantification. CMR PVL severity was graded by regurgitant fraction (RF; mild≤20%, moderate 21-39%, severe ≥40%). Short- and intermediate-term follow-up was conducted after CMR. Patients were followed-up for symptoms and a composite outcome of repeat invasive therapy, heart failure hospitalization, or death.
CMR clinical utility and follow-up symptoms.
CMR clinical utility
PVL grading reclassification
Guided further management
Short-term (≤3 months)
NYHA class improvement to I or II
Intermediate-term (~1 year)
Persistent NYHA class improvement
CMR PVL grading and prognosis.
73% outcome* free survival
p < 0.05
> Mild PVL
17% outcome* free survival
- Composite outcome*
Mean RF 11 ± 8%
p = 0.08
+ Composite outcome*
Mean RF 24 ± 19%
CMR stratifies PVL severity in symptomatic patients with suboptimal echocardiography or discrepant results. CMR is useful in guidance of specific post procedure therapy and has prognostic importance, with greater than mild PVL (RF > 20%) associated significantly with worse outcomes.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.