Klinika Wad Nabytych Serca, Instytut Kardiologii, Warszawa, ul. Alpejska 42, 04-628 Warszawa, Poland.
Kardiol Pol. 2018;76(12):1725-1732. doi: 10.5603/KP.a2018.0195. Epub 2018 Sep 13.
The use of imaging data fusion method (IDFM) with multislice computed tomography (MSCT) and two-dimensional transthoracic echocardiography (2D-TTE) in patients with aortic stenosis (AS) may result in reclassification of AS severity from severe to non-severe.
We sought to establish potential predictors of AS severity reclassification using the IDFM method.
A total of 54 high-risk patients (mean age 79 ± 7.9 years; 40.7% male) with severe AS by 2D-TTE (indexed aortic valve area [AVAi] < 0.6 cm2/m2), referred for transcatheter aortic valve implantation, were included in the analysis. AVAi was subsequently recalculated using IDFM by replacing 2D-TTE left ventricular outflow tract (LVOT) measurements with MSCT LVOT parameters.
Imaging data fusion method reclassified 20.4% patients into the potentially non-severe AS group. In a multivariable model including clinical variables, reclassification to non-severe AS by IDFM was independently associated with younger age and diabetes mellitus (DM), (odds ratio [OR] 0.864; 95% confidence interval [CI] 0.76-0.99; p < 0.035 and OR 19.259; 95% CI 2.28-162.41; p < 0.007, respectively). In a multivariable analysis of echocardiographic variables, reclassification was associ-ated with higher LVOT velocity time integral and lower aortic mean gradient (OR 1.402; 95% CI 1.07-1.84; p < 0.014 and OR 0.858; 95%: CI 0.760-0.968; p < 0.013, respectively). In addition, 24.1% of patients were reallocated from low-flow (< 35 mL/m2) to normal-flow AS.
Imaging data fusion method reclassified a substantial proportion of patients with severe AS into a potentially moderate AS group and from a low-flow to a normal-flow AS group. Such regrouping calls for increased diagnostic prudence in AS patients, especially those with specific clinical and echocardiographic predictors of reclassification, such as DM or low aortic mean gradient.
使用多排计算机断层扫描（MSCT）和二维经胸超声心动图（2D-TTE）的影像数据融合方法（IDFM）对主动脉瓣狭窄（AS）患者进行评估，可能会导致 AS 严重程度从重到非严重程度的重新分类。
我们旨在确定使用 IDFM 方法进行 AS 严重程度重新分类的潜在预测因素。
共纳入 54 例高危患者（平均年龄 79±7.9 岁，40.7%为男性），这些患者通过 2D-TTE 检查被诊断为严重 AS（索引主动脉瓣面积[AVAi]＜0.6cm2/m2），并被转诊进行经导管主动脉瓣植入术。随后使用 IDFM 重新计算 AVAi，即用 MSCT 左心室流出道（LVOT）参数替代 2D-TTE 的 LVOT 测量值。
IDFM 将 20.4%的患者重新分类为潜在的非严重 AS 组。在包括临床变量的多变量模型中，IDFM 重新分类为非严重 AS 与年龄较小和糖尿病（DM）独立相关（比值比[OR]0.864；95%置信区间[CI]0.76-0.99；p＜0.035 和 OR 19.259；95%CI2.28-162.41；p＜0.007，分别）。在超声心动图变量的多变量分析中，重新分类与更高的 LVOT 速度时间积分和更低的主动脉平均梯度相关（OR1.402；95%CI1.07-1.84；p＜0.014 和 OR0.858；95%CI0.760-0.968；p＜0.013，分别）。此外，24.1%的患者从低流量（＜35mL/m2）重新分配到正常流量 AS。
IDFM 方法将相当一部分严重 AS 患者重新分类为潜在的中度 AS 组，并将低流量 AS 重新分类为正常流量 AS。这种重新分组需要对 AS 患者进行更谨慎的诊断，特别是那些具有 DM 或低主动脉平均梯度等重新分类的特定临床和超声心动图预测因素的患者。
