University of Texas McGovern School of Medicine, Houston, Texas (ASG, DJM, DB, RJ, KP, CL, EGS, SJ, YZ, PB, TCN, AE, IDG, PL, BK, RWS, AD).
University of Texas McGovern School of Medicine, Houston, Texas (ASG, DJM, DB, RJ, KP, CL, EGS, SJ, YZ, PB, TCN, AE, IDG, PL, BK, RWS, AD); Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas (PB, TCN, AE, RWS, AD).
Am J Cardiol. 2020 Oct 1;132:114-118. doi: 10.1016/j.amjcard.2020.07.003. Epub 2020 Jul 11.
Routine preprocedural chest and abdomen computed tomography is done prior to transcatheter aortic valve implantation (TAVI), which, in turn, have led to the discovery of radiographic potentially malignant incidental masses (pMIM). It is largely unknown whether pMIM impact the outcomes of patients undergoing TAVI. In this retrospective cohort study from a single center, 1,081 patients underwent TAVI from 2012 to 2016, who had available computed tomographies, survived the index hospitalization, and also had 1 year follow-up data for review. Machine learning (backward propagation neural network)-augmented multivariable regression for mortality by pMIM was conducted. In this cohort of 1,081 patients, the mean age was 79.1 (± 9.0), 48.8% were females, 16.8% had a history of prior malignancy, and 21.1% had pMIM. One-year mortality for the entire cohort was 12.6%. The most common prior malignancies were prostate, breast, and lymphoma and the most common pMIM were present in the lung, kidneys, and thyroid. In a fully adjusted regression analysis, neither prior malignancy nor pMIM increased mortality odds. However, having both was associated with a higher 1-year mortality (odds ratio 4.02, 95% confidence interval 1.50 to 10.73, p = 0.006). In conclusion, presence of pMIM alone was not associated with an increased 1-year mortality among patients undergoing TAVI. However, the presence of pMIM and a history of prior malignancy was associated with a significant increase in 1-year mortality.
在经导管主动脉瓣植入术（TAVI）前常规进行胸部和腹部计算机断层扫描，这反过来又导致了放射学上潜在恶性偶然肿块（pMIM）的发现。目前尚不清楚 pMIM 是否会影响接受 TAVI 的患者的结局。在这项来自单一中心的回顾性队列研究中，2012 年至 2016 年期间有 1081 例患者接受了 TAVI，这些患者有可用的计算机断层扫描，在指数住院期间存活下来，并且有 1 年的随访数据可供审查。采用机器学习（反向传播神经网络）增强 pMIM 死亡率的多变量回归进行分析。在这 1081 例患者队列中，平均年龄为 79.1（±9.0）岁，48.8%为女性，16.8%有恶性肿瘤病史，21.1%有 pMIM。整个队列的 1 年死亡率为 12.6%。最常见的既往恶性肿瘤是前列腺癌、乳腺癌和淋巴瘤，最常见的 pMIM 存在于肺部、肾脏和甲状腺。在完全调整的回归分析中，既往恶性肿瘤和 pMIM 均未增加死亡率的几率。然而，同时存在这两种情况与 1 年死亡率升高相关（优势比 4.02，95%置信区间 1.50 至 10.73，p=0.006）。总之，在接受 TAVI 的患者中，仅存在 pMIM 与 1 年死亡率增加无关。然而，存在 pMIM 和既往恶性肿瘤史与 1 年死亡率的显著增加相关。
