Hemodynamic Assessment of Aortic Regurgitation after Transcatheter Aortic Valve Replacement: The Diastolic Pressure-Time Index

Objectives Assessment of aortic regurgitation (AR) immediately after transcatheter aortic valve replacement (TAVR) is essential to guide further intervention in cases of relevant AR. It was the aim of this study to identify a simple and reproducible hemodynamic parameter for the assessment of AR. Background Relevant AR after TAVR is present in up to 21% of cases and might be associated with adverse long-term outcomes. Methods Three hundred sixty-two consecutive patients who were treated with TAVR for symptomatic aortic valve stenosis were analyzed. AR was assessed by aortic root angiography according to the Sellers classification. For hemodynamic evaluation, the diastolic pressure-time (DPT) index was calculated after TAVR: the area between the aortic and left ventricular pressure-time curves was measured during diastole and divided by the duration of diastole to calculate the DPT index. The DPT index was finally adjusted for the respective systolic blood pressure: DPT index_adj = (DPT index/systolic blood pressure) × 100. Results Patients with angiographically nonrelevant AR (grade <2) had higher DPT index_adj (30.7 ± 6.8) compared with those with relevant AR (grade ≥2) (26.2 ± 5.8) (p < 0.05). Patients with DPT index_adj ≤27.9 had significantly higher 1-year mortality risk in comparison with those with DPT index_adj >27.9: 41.4% versus 13.5% (hazard ratio: 3.8; 95% confidence interval: 2.4 to 5.9; p [log rank-test] < 0.001). In multivariate regression analysis, DPT index_adj ≤27.9 was the strongest independent predictor of 1-year mortality (hazard ratio: 2.5; 95% confidence interval: 1.8 to 3.7; p < 0.001). Conclusions DPT index_adj is a simple, investigator-independent parameter that should be considered to differentiate between relevant and nonrelevant AR after TAVR.