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Updated: Feb 11, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves
Tarique Al Musa1, Akhlaque Uddin1, Laura E Dobson1
1Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Insights
The Lotus valve showed less aortic regurgitation (AR) immediately after TAVR compared to the CoreValve. At 6 months, both TAVR valves demonstrated similar AR and hemodynamics, with no significant differences in left ventricular remodeling.
Area of Science:
- Cardiovascular imaging and intervention
- Prosthetic heart valves
- Transcatheter aortic valve replacement (TAVR)
Background:
- Aortic regurgitation (AR) after TAVR is linked to poorer outcomes.
- Cardiovascular magnetic resonance (CMR) accurately quantifies AR.
- Newer generation valves aim to reduce AR and improve patient results.
Purpose of the Study:
- To compare AR and hemodynamics between the first-generation CoreValve and second-generation Lotus valve using serial CMR.
- To assess changes in AR and valve function at 6 months post-TAVR.
Main Methods:
- Fifty-one patients undergoing TAVR were enrolled.
- Serial CMR imaging was performed immediately pre-TAVR, immediately post-TAVR, and at 6 months.
- AR fraction and pressure gradients were quantified.
Main Results:
- Immediately post-TAVR, the Lotus valve group had significantly less AR (4.3% vs. 11.7%) and no moderate AR compared to the CoreValve group.
- The CoreValve group initially had a lower residual peak pressure gradient (14.1 mmHg vs. 25.4 mmHg).
- At 6 months, AR fraction and pressure gradients were comparable between both valve types, with no instances of moderate AR.
Conclusions:
- The Lotus valve demonstrated less AR immediately post-TAVR, while the CoreValve had a lower initial pressure gradient.
- Both TAVR devices achieved comparable valve hemodynamics and left ventricular reverse remodeling at 6 months.
- Serial CMR effectively tracked valve performance and AR changes over time.
Objectives:
We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA).
Background:
Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes.
Methods:
Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months.
Results:
CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months.
Conclusion:
Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.
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