Buckert Dominik, Tibi Raid, Cieslik Maciej, Radermacher Michael, Qu Yang-Yang, Rasche Volker, Bernhardt Peter, Hombach Vinzenz, Rottbauer Wolfgang, Wöhrle Jochen
University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Cardiol J. 2018;25(2):203-212. doi: 10.5603/CJ.a2017.0121. Epub 2017 Oct 24.
Objective of this study was to make an assessment of standard functional and defor-mation parameters (strain) in patients after transcatheter aortic valve replacement (TAVR) by cardiac magnetic resonance imaging (CMR) and the evaluation of their prognostic impact.
Patients undergoing TAVR received CMR on a 1.5 T whole-body scanner at 3 months after the procedure. Deformation parameters (strain, strain rate, velocity, displacement) were assessed in lon-gitudinal, circumferential and radial orientation using a feature tracking approach. Primary outcome measure was defined according to Valve Academic Research Consortium-2 (VARC-2) criteria.
Eighty-three patients formed the study population. Deformation parameters were significantly reduced in all three orientations for strain (longitudinal: -12.1 ± 5.4% vs. -15.9 ± 1.96%, p < 0.0001; radial: 34.4 ± 15.3% vs. 47.2 ± 11.4%, p < 0.0001; circumferential: -16.8 ± 4.3% vs. -21.1 ± 2.5%, p < 0.0001) and strain rate (longitudinal: -0.79 ± 0.33%/s vs. -0.91 ± 0.23%/s, p = 0.043; radial: 2.5 ± 1.2%/s vs. 2.9 ± 0.9%, p = 0.067; circumferential: -1.1 ± 0.6%/s vs. -1.3 ± 0.3%/s, p = 0.006) in comparison to a healthy control population. Median follow-up was 614 days. During this period, 13 endpoints occurred (cumulative event rate of 10.7%). Patients with event by trend exhibited poorer strain and strain rate in longitudinal and radial orientation without reaching statistical significance (longitudinal strain: -11.2 ± 5.4% vs. -12.3 ± 5.4%, p = 0.52; longitudinal strain rate: -0.73 ± ± 0.23%/s vs. 0.80 ± 0.35%/s, p = 0.53; radial strain: 29.5 ± 19.6% vs. 35.2 ± 14.5%, p = 0.24; radial strain rate: 2.2 ± 1.6%/s vs. 2.6 ± 1.2%/s, p = 0.31).
Assessment of left ventricular deformation parameters by CMR revealed functional abnormalities in comparison to healthy controls. Prognostic significance remains to be further investi-gated.
本研究的目的是通过心脏磁共振成像（CMR）评估经导管主动脉瓣置换术（TAVR）后患者的标准功能和变形参数（应变），并评估其预后影响。
接受TAVR的患者在术后3个月于1.5T全身扫描仪上进行CMR检查。使用特征跟踪方法在纵向、圆周和径向方向评估变形参数（应变、应变率、速度、位移）。主要结局指标根据瓣膜学术研究联合会-2（VARC-2）标准定义。
83名患者构成研究人群。与健康对照人群相比，所有三个方向的应变（纵向：-12.1±5.4%对-15.9±1.96%，p<0.0001；径向：34.4±15.3%对47.2±11.4%，p<0.0001；圆周：-16.8±4.3%对-21.1±2.5%，p<0.0001）和应变率（纵向：-0.79±0.33%/秒对-0.91±0.23%/秒，p=0.043；径向：2.5±1.2%/秒对2.9±0.9%，p=0.067；圆周：-1.1±0.6%/秒对-1.3±0.3%/秒，p=0.006）的变形参数均显著降低。中位随访时间为614天。在此期间，发生了13个终点事件（累积事件发生率为10.7%）。有事件发生趋势的患者在纵向和径向方向的应变和应变率较差，但未达到统计学意义（纵向应变：-11.2±5.4%对-12.3±5.4%，p=0.52；纵向应变率：-0.73±0.23%/秒对0.80±0.35%/秒，p=0.53；径向应变：29.5±19.6%对35.2±14.5%，p=0.24；径向应变率：2.2±1.6%/秒对2.6±1.2%/秒，p=0.31）。
CMR评估左心室变形参数显示与健康对照相比存在功能异常。其预后意义仍有待进一步研究。
