CT 测定的三尖瓣环扩张与 TAVR 患者 2 年死亡率升高相关。
CT-Determined Tricuspid Annular Dilatation Is Associated With Increased 2-Year Mortality in TAVR Patients.
机构信息
Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich, Munich, Germany.
Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich, Munich, Germany.
出版信息
JACC Cardiovasc Interv. 2020 Nov 9;13(21):2497-2507. doi: 10.1016/j.jcin.2020.06.027. Epub 2020 Oct 14.
OBJECTIVES
The aim of this study was to investigate the prevalence and prognostic impact of tricuspid annular dilatation (TAD) measured in multislice computed tomography datasets in patients undergoing transfemoral transcatheter aortic valve replacement for severe aortic stenosis.
BACKGROUND
TAD is an increasingly recognized entity associated with poor outcomes in patients with valvular heart disease.
METHODS
The maximal septolateral diameter of the tricuspid annulus was measured in consecutive patients with 3-dimensional multidetector row computed tomographic datasets undergoing transfemoral transcatheter aortic valve replacement. Receiver-operating curve characteristic analysis was performed to obtain an ideal, body surface area-normalized cutoff for TAD. Ethical approval was obtained from the institutional ethics board.
RESULTS
The study included 1,137 patients, of whom 299 died within a mean follow-up period of 1.8 ± 1.0 years. TAD was identified in 446 patients (39.2%) on the basis of a receiver-operating characteristic cutoff of 23 mm/m. TAD had no impact on procedural outcomes, including device failure defined according to Valve Academic Research Consortium-2 criteria. Patients with TAD experienced significantly greater mortality (hazard ratio: 1.99; 95% confidence interval: 1.59 to 2.51; p < 0.001). Multivariate analysis including clinical and echocardiographic parameters confirmed the predictive value of TAD (hazard ratio: 1.78; 95% confidence interval: 1.33 to 2.38; p < 0.001), while echocardiographic variables, including estimated pulmonary artery pressure and the severity of tricuspid regurgitation, did not reach statistical significance. The predictive value of TAD was incremental to a baseline model of clinical and echocardiographic parameters (continuous net reclassification improvement 0.204; p < 0.01) and incremental to the Society of Thoracic Surgeons score (continuous net reclassification improvement 0.209; p < 0.001).
CONCLUSIONS
TAD is an independent predictor of all-cause mortality in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
目的
本研究旨在探讨经股动脉经导管主动脉瓣置换术治疗重度主动脉瓣狭窄患者多层螺旋 CT 数据集测量的三尖瓣环扩张（TAD）的患病率及其对预后的影响。
背景
TAD 是瓣膜性心脏病患者预后不良的一个日益被认可的实体。
方法
对接受经股动脉经导管主动脉瓣置换术的 3 维多排 CT 数据集的连续患者进行 TAD 最大隔侧径测量。进行接收者操作特征曲线特征分析，以获得 TAD 的理想体表面积归一化截断值。获得机构伦理委员会的伦理批准。
结果
该研究纳入了 1137 例患者，其中 299 例在平均 1.8±1.0 年的随访期间内死亡。根据 23mm/m 的接收者操作特征截断值，446 例（39.2%）患者存在 TAD。TAD 对手术结果无影响，包括根据 Valve Academic Research Consortium-2 标准定义的器械故障。存在 TAD 的患者死亡率显著更高（风险比：1.99；95%置信区间：1.59 至 2.51；p<0.001）。包括临床和超声心动图参数的多变量分析证实了 TAD 的预测价值（风险比：1.78；95%置信区间：1.33 至 2.38；p<0.001），而包括估计肺动脉压和三尖瓣反流严重程度在内的超声心动图变量则无统计学意义。TAD 的预测价值较临床和超声心动图参数的基线模型具有增量价值（连续净重新分类改善 0.204；p<0.01），且较胸外科医师协会评分具有增量价值（连续净重新分类改善 0.209；p<0.001）。
结论
TAD 是经导管主动脉瓣置换术治疗重度主动脉瓣狭窄患者全因死亡率的独立预测因素。
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