Eberhard Matthias, Mastalerz Monika, Pavicevic Jovana, Frauenfelder Thomas, Nietlispach Fabian, Maisano Francesco, Tanner Felix C, Nguyen-Kim Thi Dan Linh
Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
Int J Cardiovasc Imaging. 2017 Oct;33(10):1637-1651. doi: 10.1007/s10554-017-1180-5. Epub 2017 May 26.
To assess the value of computed tomography (CT) for non-invasive detection of pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and to correlate CT measurements and signs with mortality after TAVI. 257 TAVI patients (median 84 years; 134 females) with both right heart catheterisation (RHC) and CT within 3 days were retrospectively analyzed. According to guidelines PH was defined as mean pulmonary artery pressure ≥25 mmHg in RHC. CT-signs for PH assessment were evaluated. Clinical data was recorded before and at 30 days, 1 year and 2 years after TAVI. 161 patients exhibited PH (median 83 years; 90 females). In patients with PH, main pulmonary artery diameter (MPA; p < 0.001) and anterior pericardial recess (PR; p = 0.003) were significantly larger. Furthermore, pleural effusion (p < 0.001) was significantly more common. Sensitivity and specificity for predicting PH were calculated for MPA diameter ≥29 mm (56 and 61%), PR diameter ≥10 mm (37 and 82%), and presence of pleural effusion (42 and 91%). Patients with PH showed significantly higher 2 years mortality after TAVI (30 vs. 17%; p = 0.01) with a Hazard ratio (HR) of 2.5 (95% CI 1.1-5.8; p = 0.027). Pleural effusion was a predictor of higher 2-year-all-cause mortality after TAVI (42 vs. 20%; p = 0.022) with a HR of 2.0 (95% CI 1.0-3.8; p = 0.042). Patients with symptomatic AS and PH at baseline display higher 2 year-all-cause mortality after TAVI. Several CT-signs suggest the presence of PH in TAVI patients with moderate to high specificity, but low sensitivity. Pleural effusion in CT is a predictor of higher 2 year-all-cause mortality.
评估计算机断层扫描（CT）在经导管主动脉瓣植入术（TAVI）的严重主动脉瓣狭窄患者中无创检测肺动脉高压（PH）的价值，并将CT测量结果和征象与TAVI术后死亡率相关联。对257例在3天内同时进行了右心导管检查（RHC）和CT检查的TAVI患者（中位年龄84岁；134例女性）进行回顾性分析。根据指南，RHC中PH定义为平均肺动脉压≥25 mmHg。评估用于PH评估的CT征象。记录TAVI术前、术后30天、1年和2年的临床数据。161例患者存在PH（中位年龄83岁；90例女性）。PH患者的主肺动脉直径（MPA；p＜0.001）和心包前隐窝（PR；p = 0.003）明显更大。此外，胸腔积液（p＜0.001）明显更常见。计算MPA直径≥29 mm（敏感性56%，特异性61%）、PR直径≥10 mm（敏感性37%，特异性82%）和存在胸腔积液（敏感性42%，特异性91%）预测PH的敏感性和特异性。PH患者TAVI术后2年死亡率明显更高（30%对17%；p = 0.01），风险比（HR）为2.5（95%可信区间1.1 - 5.8；p = 0.027）。胸腔积液是TAVI术后2年全因死亡率较高的预测因素（42%对20%；p = 0.022），HR为2.0（95%可信区间1.0 - 3.8；p = 0.042）。基线时伴有症状性AS和PH的患者TAVI术后2年全因死亡率更高。几种CT征象提示TAVI患者存在PH，特异性中等至高，但敏感性低。CT中的胸腔积液是2年全因死亡率较高的预测因素。
