Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
Ann Thorac Surg. 2013 Nov;96(5):1574-80. doi: 10.1016/j.athoracsur.2013.06.049. Epub 2013 Sep 24.
The purpose of this study was to quantify and characterize aortic valve leaflet and aortic annular calcification with computed tomography angiography (CTA) and to define whether they predict paravalvular regurgitation (PAR) after transcatheter aortic valve implantation.
In all, 94 patients (aged 83.6 years) with severe aortic stenosis underwent CTA. Annular calcification was measured in two planes and defined as "protruding" (depth greater than length), "round," or "adherent" (length less than depth) for the right, left, and noncoronary annulus. Leaflet calcification severity and asymmetry were scored. Transthoracic echocardiography graduation of PAR severity was performed after the procedure (0.5 scale).
Thirty-two percent of patients had no or trivial PAR (grade less than 1) and 68% had mild to severe PAR (≥ 1 [mild 45.7%, moderate 20.2%, moderate to severe 2.1%]). The size of annular calcium was higher in patients with moderate to severe PAR greater than 1 (p = 0.015, p = 0.007, and p = 0.004) and predictive (c = 0.67, 0.71, and 0.711) for noncoronary, left, and total annular calcium size, respectively. Increasing PAR severity was correlated with increasing total calcium size (r = 0.422, p < 0.001). Protruding annular calcification greater than 4 mm (p = 0.02) was more frequently found in moderate to severe PAR greater than 1, and predictive (c = 0.7). Adherent calcium greater than 4 mm did not predict PAR greater than 1 and PAR of 1 or less. There was no association of leaflet calcium severity and asymmetry with PAR severity.
Protruding annular calcium greater than 4 mm predicts moderate to severe PAR after transcatheter aortic valve implantation. Increasing annular calcium size is another predictor, whereas adherent calcium has a "sealing" effect.
本研究旨在通过计算机断层扫描血管造影（CTA）量化和描述主动脉瓣叶和主动脉瓣环钙化，并确定其是否可预测经导管主动脉瓣植入术后瓣周漏（PAR）。
共纳入 94 例（年龄 83.6 岁）严重主动脉瓣狭窄患者行 CTA 检查。在两个平面测量瓣环钙化，将右、左和无冠瓣环的钙化定义为“突出”（深度大于长度）、“圆形”或“粘连”（长度小于深度）。对瓣叶钙化严重程度和不对称性进行评分。术后进行经胸超声心动图 PAR 严重程度分级（0.5 级）。
32%的患者无 PAR 或 PAR 较轻（<1 级），68%的患者有轻度至重度 PAR（≥1 级[轻度 45.7%，中度 20.2%，中重度 2.1%]）。中度至重度 PAR 大于 1 级患者的瓣环钙大小较高（p=0.015，p=0.007，p=0.004），且分别对无冠瓣环、左瓣环和总瓣环钙大小具有预测价值（c=0.67、0.71 和 0.711）。PAR 严重程度的增加与总钙大小的增加相关（r=0.422，p<0.001）。大于 4mm 的突出瓣环钙化（p=0.02）在中度至重度 PAR 大于 1 级中更常见，且具有预测价值（c=0.7）。大于 4mm 的粘连钙不能预测 PAR 大于 1 级和 PAR 小于等于 1 级。瓣叶钙严重程度和不对称性与 PAR 严重程度无关。
大于 4mm 的突出瓣环钙预测经导管主动脉瓣植入术后中度至重度 PAR。瓣环钙大小的增加是另一个预测因素，而粘连钙具有“密封”作用。
