Trenkwalder Teresa, Lahmann Anna Lena, Nowicka Magdalena, Pellegrini Costanza, Rheude Tobias, Mayr N Patrick, Voss Stephanie, Bleiziffer Sabine, Lange Rüdiger, Joner Michael, Kasel Albert M, Kastrati Adnan, Schunkert Heribert, Husser Oliver, Hadamitzky Martin, Hengstenberg Christian
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Int J Cardiovasc Imaging. 2018 Jun;34(6):985-992. doi: 10.1007/s10554-018-1305-5. Epub 2018 Feb 21.
Multislice computed tomography (MSCT) has emerged as the mainstay in patients planned for transcatheter aortic valve implantation (TAVI). Incidental findings (IF) in MSCT are common. However, the exact incidence, clinical relevance and further consequences of IF are unclear and it is controversial whether IF adversely affect patients' outcome. We analyzed MSCT data of 1050 patients screened for TAVI between January 2011 and December 2014. Median follow-up of patients was 20 months. In total, 3194 IF were identified, which were classified into clinically non-relevant IF (2872, 90%) and clinically relevant IF (322, 10%). In 25% of patients (258/1050) at least one clinically relevant IF was present. Age (80 ± 7 vs. 80 ± 7 years; p = 0.198) and EuroSCORE II (3.6% [2.1-5.7] vs. 3.6% [2.1-5.9]; p = 0.874) was similar between patients with and without a clinically relevant IF. TAVI was performed less frequently in patients with a clinically relevant IF (76% vs. 85%; p < 0.001), with more patients receiving surgical aortic valve replacement in that group (14% vs. 11%; p = 0.042), possibly due to the high rate of incidental aneurysms of the ascending aorta (n = 48). If TAVI was performed mortality did not differ (30-days: 4% vs. 3%; p = 0.339, 1-year: 11% vs. 14%; p = 0.226) between patients with and without a clinically relevant IF. Our study is the largest study to analyze prevalence, clinical relevance and therapeutic consequences of IF during screening for TAVI. IF in pre-procedural MSCT are common and clinically relevant in one-quarter of patients. However, these findings had no impact on overall mortality.
多层螺旋计算机断层扫描（MSCT）已成为计划进行经导管主动脉瓣植入术（TAVI）患者的主要检查手段。MSCT检查中偶然发现（IF）很常见。然而，IF的确切发生率、临床相关性及进一步后果尚不清楚，且IF是否会对患者预后产生不利影响也存在争议。我们分析了2011年1月至2014年12月期间接受TAVI筛查的1050例患者的MSCT数据。患者的中位随访时间为20个月。共识别出3194项IF，分为临床无关IF（2872项，90%）和临床相关IF（322项，10%）。25%的患者（258/1050）至少存在一项临床相关IF。有临床相关IF和无临床相关IF的患者在年龄（80±7岁 vs. 80±7岁；p = 0.198）和欧洲心脏手术风险评估系统II（EuroSCORE II）（3.6% [2.1 - 5.7] vs. 3.6% [2.1 - 5.9]；p = 0.874）方面相似。有临床相关IF的患者接受TAVI的频率较低（76% vs. 85%；p < 0.001），该组中接受外科主动脉瓣置换术的患者更多（14% vs. 11%；p = 0.042），这可能是由于升主动脉偶然动脉瘤的发生率较高（n = 48）。如果进行了TAVI，有临床相关IF和无临床相关IF的患者死亡率无差异（30天：4% vs. 3%；p = 0.339，1年：11% vs. 14%；p = 0.226）。我们的研究是分析TAVI筛查期间IF的患病率、临床相关性及治疗后果的最大规模研究。术前MSCT中的IF很常见，在四分之一的患者中具有临床相关性。然而，这些发现对总体死亡率没有影响。
