Cardiac MR guided TAVR effective option to CT-guided TAVR

Written By : Aditi |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-09-29T11:00:30+05:30 | Updated On 29 Sept 2023 12:30 PM IST

Though Computed tomography (CT) is recommended for guiding TAVR, it is associated with limitations. CMR is a promising alternative, and studies are required to compare the effectiveness of CMR- versus CT-guided TAVR ( transcatheter aortic valve replacement). In a latest study published in Circulation, Dr. Martin Reindl recommended Cardiac magnetic resonance (CMR) as an ALTERNATIVE to TAVR planning. In this study, the team reported CMR-guided TAVR as non-inferior to CT-guided TAVR pertaining to the device implantation success.

For guiding TAVR, CT is recommended, but since TAVR candidates have chronic kidney disease (CKD), using iodinated contrast media poses a limitation. CMR could be a promising alternative but requires data to clarify "How effective is CMR- versus CT-guided TAVR?" This background was further investigated in the present study. Researchers conducted a trial at two Austrian heart centres.

Based on inclusion (severe symptomatic aortic stenosis) and exclusion criteria (contraindication to CMR, CT, or TAVR, a life expectancy < 1 year, CKD 4 or 5), patients were evaluated for TAVR. These were randomized to a 1:1 ratio for CMR- or CT-guiding. The primary outcomes measured were, absence of procedural mortality, correct positioning of a single prosthetic valve and proper prosthetic valve performance.

These were defined based on the Valve Academic Research Consortium-2 definition of implantation success at discharge. Non-inferiority was assessed using a hybrid modified intention-to-treat (mITT)/per-protocol (PP) approach (absolute risk difference margin of 9%).

The key results of the study are:

Three hundred eighty candidates for TAVR were randomized to CMR-guided and CT-guided TAVR planning, including 191 and 189 patients.
72.3 % and 68.3 % in the CMR and CR guided group underwent TAVR, respectively. This included 138 patients and 129 patients, respectively.
267, 19 patients had protocol deviations, resulting in a PP cohort of 248, including 121 and 127 patients in CMR-guided and CT-guided, respectively.
In the mITT cohort, implantation success was achieved in 129 patients and 117 patients in the CMR and CT group, constituting 93.5% and 90.7%, respectively.
The between-group difference recorded was 2.8%.
The between-group difference was 2.0% for the PP cohort.

They concluded the study by saying, "In our study, we report non-inferiority of CMR-guided TAVR to CT-guided TAVR pertaining to device implantation success."

CMR could be an alternative for TAVR planning, they noted.

BDS, MDS in Periodontics and Implantology

Dr. Aditi Yadav is a BDS, MDS in Periodontics and Implantology. She has a clinical experience of 5 years as a laser dental surgeon. She also has a Diploma in clinical research and pharmacovigilance and is a Certified data scientist. She is currently working as a content developer in e-health services. Dr. Yadav has a keen interest in Medical Journalism and is actively involved in Medical Research writing.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751