与球囊扩张式经导管主动脉瓣置换术相关的主动脉根部损伤中钙含量及分布的影响
The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement.
作者信息
Hansson Nicolaj C, Nørgaard Bjarne L, Barbanti Marco, Nielsen Niels Erik, Yang Tae-Hyun, Tamburino Corrado, Dvir Danny, Jilaihawi Hasan, Blanke Phillip, Makkar Raj R, Latib Azeem, Colombo Antonio, Tarantini Giuseppe, Raju Rekha, Wood David, Andersen Henning R, Ribeiro Henrique B, Kapadia Samir, Min James, Feuchtner Gudrun, Gurvitch Ronen, Alqoofi Faisal, Pelletier Marc, Ussia Gian Paolo, Napodano Massimo, Sandoli de Brito Fabio, Kodali Susheel, Pache Gregor, Canovas Sergio J, Berger Adam, Murphy Darra, Svensson Lars G, Rodés-Cabau Josep, Leon Martin B, Webb John G, Leipsic Jonathon
机构信息
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Aarhus, Denmark.
出版信息
J Cardiovasc Comput Tomogr. 2015 Sep-Oct;9(5):382-92. doi: 10.1016/j.jcct.2015.04.002. Epub 2015 Apr 18.
BACKGROUND
A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR).
OBJECTIVE
We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR.
METHODS
Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region.
RESULTS
Calcium volumes in the upper LVOT (median, 29 vs 0 mm(3); P < .0001) and overall LVOT (median, 74 vs 3 mm(3); P = .0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P = .010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P = .028) and redilatation (likelihood ratio test, P = .015) improved prediction of aortic root injury by upper LVOT calcium volume.
CONCLUSION
Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.
背景
对主动脉根部的钙进行详细评估可能会提供有关经导管心脏瓣膜置换术（TAVR）期间主动脉根部损伤风险的重要额外信息。
目的
我们试图确定钙的体积和分布对TAVR期间主动脉根部损伤的影响。
方法
将33例在TAVR期间使用球囊扩张瓣膜时发生主动脉根部损伤的患者与153例连续的无主动脉根部损伤的TAVR患者对照组进行比较（通过TAVR后多排CT评估）。使用商业软件分析TAVR前的对比增强CT扫描，在3个区域确定钙体积：（1）整个左心室流出道（LVOT），从主动脉瓣环平面向下延伸10毫米；（2）上部LVOT，从瓣环平面向下延伸2毫米；（3）主动脉瓣区域。
结果
与对照组相比，发生主动脉根部损伤的患者上部LVOT（中位数，29 vs 0立方毫米；P <.0001）和整个LVOT（中位数，74 vs 3立方毫米；P =.0001）的钙体积更高。主动脉瓣区域的钙在两组之间没有差异。上部LVOT钙体积比整个LVOT钙体积更能预测主动脉根部损伤（受试者工作特征曲线下面积[AUC]，0.78；95%置信区间，0.69 - 0.86 vs AUC，0.71；95%置信区间，0.62 - 0.82；P =.010）。与右冠状动脉瓣叶或左冠状动脉瓣叶下方的钙相比，无冠状动脉瓣叶下方的上部LVOT钙更能显著预测主动脉根部损伤（AUC，0.81 vs 0.68 vs 0.64）。假体过大>20%（似然比检验，P =.028）和再次扩张（似然比检验，P =.015）改善了上部LVOT钙体积对主动脉根部损伤的预测。
结论
LVOT钙化，尤其是上部LVOT，位于无冠状动脉瓣叶下方并从瓣环区域延伸，可预测使用球囊扩张瓣膜的TAVR期间的主动脉根部损伤。
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