All patients undergoing TAVI should first receive 3D imaging, an Australian expert says, as research shows it is far superior to echocardiography for predicting post-procedural aortic regurgitation.
Dr Andrew Jabbour, an Australian cardiologist working at London’s Imperial College, led the study of 202 TAVI candidates who underwent pre-procedural magnetic resonance (CMR), computed tomography (CCT) and transthoracic echocardiography (TTE) imaging.
Writing in the Journal of the American College of Cardiology, Dr Jabbour and colleagues noted that significant aortic regurgitation (AR) was linked with adverse outcomes after TAVI, and that studies showed it could be predicted by pre-procedural aortic root imaging.
But studies to date had been small and limited to single imaging modalities, they noted.
Their study found pre-procedural TTE – the technique used by many centres for TAVI size selection – was not helpful for predicting post-procedural AR.
But larger aortic annulus measurements by both CMR and CCT were significantly associated with the presence and severity of AR three days after TAVI.
Aortic root measurements made by both CMR and CCT were highly reproducible and showed close agreement, but TTE-derived measures displayed higher variability.
Dr Jabbour told Cardiology Update that on the basis of these results “patients should all undergo a 3D imaging study prior to TAVI”.
“This would allow physicians and surgeons to better plan their implantation strategy and permit further research for implantation refinement in the future,” he said.
TTE was limited, he added, because as a 2D strategy, it did not account for the ellipsoid architecture of the annulus.
The best aortic root measure to use in planning TAVI sizing was still yet to be definitively determined, he said, adding that an international multi-centre study was exploring this issue.
However in their paper, Dr Jabbour and colleagues said optimal coverage of the AV annulus was desirable to prevent AR, and that this most likely to be achieved if the largest AV annulus diameter was used.