Watanabe Yusuke, Lefèvre Thierry, Bouvier Erik, Arai Takahide, Hayashida Kentaro, Chevalier Bernard, Romano Mauro, Hovasse Thomas, Garot Philippe, Donzeau-Gouge Patrick, Farge Arnaud, Cormier Bertrand, Morice Marie-Claude
Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
Catheter Cardiovasc Interv. 2015 Nov 15;86(6):1105-13. doi: 10.1002/ccd.25986. Epub 2015 May 6.
Few data are available about whether aortic root calcification may impact the outcomes after transcatheter aortic valve implantation (TAVI).
This study sought to evaluate the impact of aortic root calcification volume on clinical outcome after TAVI with balloon expandable Edwards Sapien XT valve (Edwards Lifesciences, Irvine, California).
A total of 162 TAVI patients (aged 84.0 [Interquartile Range (IQR) 81.0-84.0] years, Logistic EuroSCORE 14.5 [IQR 9.8-25.1]) with preprocedural MDCT were studied. Aortic root calcification volume was measured by MDCT image and using the dedicated software for aortic valve assessment (the automated 3mensio™ Valves 5.1, sp1, 3mensio Pie Medical Imaging BV, Maastricht, the Netherlands). A valve calcification index (VCI) was defined as calcification volume (mm(3))/body surface area (mm(2)).
VCI was significantly higher among patients with 30-day mortality. A VCI threshold of 517.4 (area under the curve 0.69, 95% CI 0.50-0.87, P = 0.03) predicted a higher incidence of annulus rupture (9.1 vs. 0.9%, P = 0.02) and cardiac tamponade (12.7 vs. 1.9%, P < 0.01), lower device success (83.6% vs. 95.3%, P < 0.01) and 30-day survival rate (80.0% vs. 97.2%, P < 0.01). Multivariate logistic regression analysis showed only ejection fraction and VCI were identified as independent predictors of 30-day mortality (Odds ratio 0.948 [95% confidence interval 0.909-0.988], P = 0.012, Odds ratio 1.003 [95% confidence interval 1.001-1.005], P = 0.013, respectively).
Significantly worse acute clinical outcomes after Edwards valve implantation were observed in patients with large amount of aortic annulus calcifications quantitatively measured by dedicated MDCT software. Application of VCI may prove helpful in prediction of clinical outcomes after TAVI.
关于主动脉根部钙化是否会影响经导管主动脉瓣植入术（TAVI）后的预后，目前可用数据较少。
本研究旨在评估主动脉根部钙化体积对使用球囊扩张式爱德华兹Sapien XT瓣膜（爱德华兹生命科学公司，加利福尼亚州尔湾）进行TAVI术后临床结局的影响。
对162例行TAVI术前进行MDCT检查的患者（年龄84.0[四分位数间距（IQR）81.0 - 84.0]岁，逻辑欧洲心脏手术风险评估系统评分为14.5[IQR 9.8 - 25.1]）进行研究。通过MDCT图像并使用专门的主动脉瓣评估软件（自动3mensio™瓣膜5.1，sp1，3mensio Pie Medical Imaging BV，荷兰马斯特里赫特）测量主动脉根部钙化体积。瓣膜钙化指数（VCI）定义为钙化体积（mm³）/体表面积（mm²）。
30天死亡率患者的VCI显著更高。VCI阈值为517.4（曲线下面积0.69，95%可信区间0.50 - 0.87，P = 0.03）时，预测瓣环破裂发生率更高（9.1%对0.9%，P = 0.02）和心包填塞发生率更高（12.7%对1.9%，P < 0.01），器械成功率更低（83.6%对95.3%，P < 0.01）以及30天生存率更低（80.0%对97.2%，P < 0.01）。多因素逻辑回归分析显示，仅射血分数和VCI被确定为30天死亡率的独立预测因素（优势比分别为0.948[95%可信区间0.909 - 0.988]，P = 0.012；优势比为1.003[95%可信区间1.001 - 1.005]，P = 0.013）。
通过专门的MDCT软件定量测量发现，主动脉瓣环钙化量大的患者在植入爱德华兹瓣膜后急性临床结局明显更差。VCI的应用可能有助于预测TAVI术后的临床结局。
