Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
Department of Radiology, Cairo University Hospitals, Cairo, Egypt; Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Eur J Radiol. 2020 Dec;133:109366. doi: 10.1016/j.ejrad.2020.109366. Epub 2020 Oct 24.
To evaluate a systolic ECG-gated high-pitch aortoiliac computed tomography (CT) angiography for planning transcatheter aortic valve implantation (TAVI).
Patients referred for TAVI underwent a combined CT imaging with retrospective, multiphasic ECG-gating of the heart and systolic ECG-gated high-pitch aortoiliac CT angiography. Consecutive patients were retrospectively included in this study group. Heart rate (HR) and heart rate variability (HRV) were assessed during the high-pitch ECG prediction phase. Aortic annulus area (AAA) was planimetrically quantified on both datasets. While only one moment of cardiac cycle was available for measurements in the high-pitch CT, the point of time in the multiphasic CT was chosen, where AAA yielded maximum size. Hypothetical prosthesis sizing was compared between multiphasic vs. high-pitch CT.
Among 61 patients (44.2 % men, mean age: 83.3 ± 5.5 years) average heart rate and HRV were 71.0 ± 13.4 bpm and 7.3 ± 8.5 bpm. 20 patients (32.7 %) had atrial fibrillation at the time of image acquisition. There was a strong correlation of AAA as derived from multiphasic vs. the high-pitch CT (r = 0.98). The difference in AAA was 10.5 ± 17.1mm (455.1 ± 83.0 mm for multiphasic vs. 444.5 ± 87.2 mm for high-pitch CT) and did not reach statistical significance (p = 0.08). Hypothetical prosthesis sizing showed an agreement in 55 of 61 patients (90.2 %). A sizing based on the high-pitch CT resulted in smaller prosthesis choice in 6 patients, all of them suffering from atrial fibrillation. Mean effective radiation dose was 10.9 ± 6.1 mSv for cardiac CTA and 4.1 ± 1.0 mSv for high-pitch CTA.
For patients with sinus rhythm, systolic high-pitch aortoiliac CTA provides adequate prosthesis size selection as compared with multiphasic ECG-gated cardiac CTA and may result in significantly reduced radiation exposition.
评估用于经导管主动脉瓣植入术（TAVI）规划的收缩期心电门控高心率主动脉髂动脉计算机断层扫描（CT）血管造影。
接受 TAVI 治疗的患者接受了心脏回顾性多期心电门控和收缩期心电门控高心率主动脉髂动脉 CT 血管造影的联合 CT 成像。连续患者被回顾性纳入本研究组。在高心率心电预测阶段评估心率（HR）和心率变异性（HRV）。在两个数据集上对主动脉瓣环面积（AAA）进行平面量化。虽然在高心率 CT 中仅获得一个心动周期的时刻，但选择多相 CT 中 AAA 产生最大尺寸的时刻。比较多相 CT 与高心率 CT 之间的假设假体尺寸。
在 61 名患者（44.2%为男性，平均年龄：83.3±5.5 岁）中，平均心率和 HRV 分别为 71.0±13.4 bpm 和 7.3±8.5 bpm。20 名患者（32.7%）在图像采集时患有心房颤动。AAA 源自多相 CT 与高心率 CT 之间存在很强的相关性（r=0.98）。AAA 的差异为 10.5±17.1mm（多相 CT 为 455.1±83.0mm，高心率 CT 为 444.5±87.2mm），无统计学意义（p=0.08）。假设假体尺寸在 61 名患者中的 55 名（90.2%）中一致。基于高心率 CT 的假体选择在 6 名患者中较小，他们都患有心房颤动。心脏 CT 血管造影的平均有效辐射剂量为 10.9±6.1 mSv，高心率 CT 血管造影为 4.1±1.0 mSv。
对于窦性心律患者，与多相心电门控心脏 CT 血管造影相比，收缩期高心率主动脉髂动脉 CT 可提供足够的假体尺寸选择，并可显著降低辐射暴露。
