Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Department of Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Eur Heart J Cardiovasc Imaging. 2020 Oct 1;21(10):1092-1102. doi: 10.1093/ehjci/jeaa100.
To assess whether the combination of transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) data affects the grading of aortic stenosis (AS) severity under consideration of the energy loss index (ELI) in patients undergoing transcatheter aortic valve replacement (TAVR).
Multimodality imaging was performed in 197 patients with symptomatic severe AS undergoing TAVR at the University Hospital Zurich, Switzerland. Fusion aortic valve area index (fusion AVAi) assessed by integrating MDCT derived planimetric left ventricular outflow tract area into the continuity equation was significantly larger as compared to conventional AVAi (0.41 ± 0.1 vs. 0.51 ± 0.1 cm2/m2; P < 0.01). A total of 62 patients (31.4%) were reclassified from severe to moderate AS with fusion AVAi being >0.6 cm2/m2. ELI was obtained for conventional AVAi and fusion AVAi based on sinotubular junction area determined by TTE (ELILTL 0.47 ± 0.1 cm2/m2; fusion ELILTL 0.60 ± 0.1 cm2/m2) and MDCT (ELIMDCT 0.48 ± 0.1 cm2/m2; fusion ELIMDCT 0.61 ± 0.05 cm2/m2). When ELI was calculated with fusion AVAi the effective orifice area was >0.6 cm2/m2 in 85 patients (43.1%). Survival rate 3 years after TAVR was higher in patients reclassified to moderate AS according to multimodality imaging derived ELI (78.8% vs. 67%; P = 0.01).
Multimodality imaging derived ELI reclassifies AS severity in 43% undergoing TAVR and predicts mid-term outcome.
评估在经导管主动脉瓣置换术（TAVR）患者中，考虑能量损失指数（ELI）的情况下，经胸超声心动图（TTE）和多排螺旋 CT（MDCT）数据的联合是否会影响主动脉瓣狭窄（AS）严重程度的分级。
在瑞士苏黎世大学医院，对 197 例接受 TAVR 的有症状严重 AS 患者进行了多模态影像学检查。通过将 MDCT 获得的左心室流出道面积的平面测量值整合到连续性方程中，评估融合的主动脉瓣口面积指数（fusion AVAi）明显大于传统的 AVAi（0.41±0.1 比 0.51±0.1cm2/m2；P<0.01）。共有 62 例患者（31.4%）的融合 AVAi>0.6cm2/m2，从严重 AS 重新分类为中度 AS。基于 TTE 确定的窦管交界区，获得了传统 AVAi 和融合 AVAi 的 ELI（ELILTL 0.47±0.1cm2/m2；fusion ELILTL 0.60±0.1cm2/m2）和 MDCT（ELIMDCT 0.48±0.1cm2/m2；fusion ELIMDCT 0.61±0.05cm2/m2）。当使用融合 AVAi 计算 ELI 时，85 例患者（43.1%）的有效瓣口面积>0.6cm2/m2。根据多模态成像衍生的 ELI 将 AS 严重程度重新分类为中度 AS 的患者，在 TAVR 后 3 年的生存率更高（78.8%比 67%；P=0.01）。
多模态成像衍生的 ELI 可重新分类 43%接受 TAVR 的患者的 AS 严重程度，并预测中期结果。
