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Novel index identifies aortic regurgitation after TAVR

LAS VEGAS — A novel dicrotic notch index identified hemodynamically significant paravalvular aortic regurgitation in patients who underwent transcatheter aortic valve replacement, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Results of this study were also published in JACC: Cardiovascular Interventions.

Divyanshu Mohananey, MD, fellow in the department of cardiovascular medicine at the Medical College of Wisconsin in Milwaukee, and colleagues analyzed data from 204 patients (median age, 81 years) who underwent TAVR with a particular valve (Sapien, Edwards Lifesciences) between 2014 and April 2016.

Transthoracic echocardiogram was performed 1 or 2 days after the procedure to measure the amount of aortic regurgitation. Significant aortic regurgitation was defined as moderate severity or worse.

The dicrotic notch index was calculated as the difference of systolic BP and dicrotic notch divided by the pulse pressure.

Of the patients in the study, 30% did not have aortic regurgitation after TAVR, 50% had trivial aortic regurgitation, 17% had mild aortic regurgitation and 2.5% had moderate aortic regurgitation.

Patients with hemodynamically significant aortic regurgitation had a lower dicrotic notch index compared with patients without aortic regurgitation (0.57 vs. 0.66; P = .04).

Based on receiver operating characteristic analysis, the dicrotic notch index had good predictive valve in finding hemodynamically significant aortic regurgitation with an area under the curve of 0.8 (95% CI, 0.69-0.91). A cutoff of less than 0.63 resulted in 100% sensitivity and a cutoff of less than 0.5 had a specificity of 95.5% when detecting hemodynamically significant aortic regurgitation.

A novel dicrotic notch index identified hemodynamically significant paravalvular aortic regurgitation in patients who underwent transcatheter aortic valve replacement, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Source: Adobe Stock

“[Dicrotic notch index] can become an additional tool, and along with [transthoracic echocardiogram], it can help identify patients who require corrective measures such as [balloon post-dilation], valve-in-valve or repositioning when possible,” Mohananey and colleagues wrote. “Additionally, as the [dicrotic notch index] is obtained from aortic pressures alone, it can function as an effective screening tool for detection of [aortic regurgitation].” – by Darlene Dobkowski

References:

Narayanswami J. Abstract Poster Session II. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2019; Las Vegas.

Mohananey D, et al. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.03.006.

Disclosures: The authors report no relevant financial disclosures.

LAS VEGAS — A novel dicrotic notch index identified hemodynamically significant paravalvular aortic regurgitation in patients who underwent transcatheter aortic valve replacement, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Results of this study were also published in JACC: Cardiovascular Interventions.

Divyanshu Mohananey, MD, fellow in the department of cardiovascular medicine at the Medical College of Wisconsin in Milwaukee, and colleagues analyzed data from 204 patients (median age, 81 years) who underwent TAVR with a particular valve (Sapien, Edwards Lifesciences) between 2014 and April 2016.

Transthoracic echocardiogram was performed 1 or 2 days after the procedure to measure the amount of aortic regurgitation. Significant aortic regurgitation was defined as moderate severity or worse.

The dicrotic notch index was calculated as the difference of systolic BP and dicrotic notch divided by the pulse pressure.

Of the patients in the study, 30% did not have aortic regurgitation after TAVR, 50% had trivial aortic regurgitation, 17% had mild aortic regurgitation and 2.5% had moderate aortic regurgitation.

Patients with hemodynamically significant aortic regurgitation had a lower dicrotic notch index compared with patients without aortic regurgitation (0.57 vs. 0.66; P = .04).

Based on receiver operating characteristic analysis, the dicrotic notch index had good predictive valve in finding hemodynamically significant aortic regurgitation with an area under the curve of 0.8 (95% CI, 0.69-0.91). A cutoff of less than 0.63 resulted in 100% sensitivity and a cutoff of less than 0.5 had a specificity of 95.5% when detecting hemodynamically significant aortic regurgitation.

A novel dicrotic notch index identified hemodynamically significant paravalvular aortic regurgitation in patients who underwent transcatheter aortic valve replacement, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Source: Adobe Stock

“[Dicrotic notch index] can become an additional tool, and along with [transthoracic echocardiogram], it can help identify patients who require corrective measures such as [balloon post-dilation], valve-in-valve or repositioning when possible,” Mohananey and colleagues wrote. “Additionally, as the [dicrotic notch index] is obtained from aortic pressures alone, it can function as an effective screening tool for detection of [aortic regurgitation].” – by Darlene Dobkowski

References:

Narayanswami J. Abstract Poster Session II. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2019; Las Vegas.

Mohananey D, et al. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.03.006.

Disclosures: The authors report no relevant financial disclosures.

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