Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
J Am Coll Cardiol. 2011 Nov 15;58(21):2165-73. doi: 10.1016/j.jacc.2011.09.010.
The purpose of this study was to determine imaging predictors of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and the agreement and reproducibility of cardiovascular magnetic resonance (CMR), cardiac computed tomography (CCT), and transthoracic echocardiography (TTE) in aortic root assessment.
The optimal imaging strategy for planning TAVI is unclear with a paucity of comparative multimodality imaging data. The association between aortic root morphology and outcomes after TAVI also remains incompletely understood.
A total of 202 consecutive patients assessed by CMR, CCT, and TTE for TAVI were studied. Agreement and variability among and within imaging modalities was assessed by Bland-Altman analysis. Postoperative AR was assessed by TTE.
Of the 202 patients undergoing TAVI assessment with both CMR and TTE, 133 also underwent CCT. Close agreement was observed between CMR and CCT in dimensions of the aortic annulus (bias, -0.4 mm; 95% limits of agreement: -5.7 to 5.0 mm), and similarly for sinus of Valsalva, sinotubular junction, and ascending aortic measures. Agreement between TTE-derived measures and either CMR or CCT was less precise. Intraobserver and interobserver variability were lowest with CMR. The presence and severity of AR after TAVI were associated with larger aortic valve annulus measurements by both CMR (p = 0.03) and CCT (p = 0.04) but not TTE-derived measures (p = 0.10). Neither CCT nor CMR measures of annulus eccentricity, however, predicted AR after TAVI (p = 0.33 and p = 0.78, respectively).
In patients undergoing imaging assessment for TAVI, the presence and severity of AR after TAVI were associated with larger aortic annulus measurements by both CMR and CCT, but not TTE. Both CMR and CCT provide highly reproducible information in the assessment of patients undergoing TAVI.
本研究旨在确定经导管主动脉瓣植入术（TAVI）后主动脉瓣反流（AR）的影像学预测因素，以及心血管磁共振（CMR）、心脏计算机断层扫描（CCT）和经胸超声心动图（TTE）在主动脉根部评估中的一致性和可重复性。
TAVI 规划的最佳影像学策略尚不清楚，且比较多模态影像学数据也很少。主动脉根部形态与 TAVI 后结局之间的关联也不完全清楚。
共对 202 例接受 TAVI 评估的患者进行了 CMR、CCT 和 TTE 检查。通过 Bland-Altman 分析评估各影像学方法之间和内部的一致性和可变性。通过 TTE 评估术后 AR。
在接受 TAVI 评估的 202 例患者中，有 133 例同时接受了 CCT。CMR 和 CCT 在主动脉瓣环的尺寸（偏差，-0.4mm；95%置信区间：-5.7 至 5.0mm）方面具有密切的一致性，在窦部、窦管交界和升主动脉测量方面也具有相似的一致性。TTE 衍生测量值与 CMR 或 CCT 的一致性不太精确。观察者内和观察者间的变异性以 CMR 最低。TAVI 后 AR 的存在和严重程度与 CMR（p=0.03）和 CCT（p=0.04）测量的主动脉瓣环均较大相关，但与 TTE 衍生测量值无关（p=0.10）。然而，CCT 和 CMR 测量的瓣环偏心度均不能预测 TAVI 后的 AR（分别为 p=0.33 和 p=0.78）。
在接受 TAVI 影像学评估的患者中，TAVI 后 AR 的存在和严重程度与 CMR 和 CCT 测量的主动脉瓣环较大有关，但与 TTE 无关。CMR 和 CCT 在评估接受 TAVI 的患者时均可提供高度可重复的信息。
