Department of Radiology, University of Maryland School of Medicine, 22 S Green St, Baltimore, MD 21201.
Department of Cardiovascular and Thoracic Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon.
AJR Am J Roentgenol. 2021 Jan;216(1):57-65. doi: 10.2214/AJR.20.22894. Epub 2020 Nov 10.
The purpose of this study is to determine whether imaging features of right heart failure seen on CT performed before transcatheter aorta valve replacement (TAVR) predict poor outcomes after the procedure.
We retrospectively evaluated findings on CT performed before TAVR for 505 consecutive patients seen from 2014 to 2018. Of these patients, 300 underwent TAVR. Patient demographic characteristics and clinical and procedural data were recorded. Imaging features, including signs of right heart failure, left heart failure, lung disease, coronary artery disease, and concomitant mitral valve and apparatus calcifications were evaluated. The primary outcome was all-cause mortality at 1 year after TAVR. Patients were divided into two groups: those who were alive (group 1) and those who had died (group 2) by 1 year after TAVR. These groups were compared using the Mann-Whitney test and the Pearson chi-square and Fisher exact tests when applicable. Multivariate logistic regression with a backward stepwise approach was performed. Results were correlated with echo-cardiography findings.
A total of 31 patients (10.3%) died within 1 year of TAVR. The presence and size of pericardial effusions were strongly associated with mortality within 1 year after TAVR ( = 0.002). Pericardial effusion was noted in 25 patients in group 1 (9.3%) and eight patients in group 2 (25.8%). Increased size of the main pulmonary artery was associated with death ( = 0.024), with a median main pulmonary artery size of 2.9 cm (interquartile range, 2.6-3.3 cm) in group 1 and 3.2 cm (interquartile range, 2.9-3.5 cm) in group 2. In multivariate analysis, pericardial effusion size and pulmonary artery size, both of which are indicative of right heart failure, were predictors of death, independent of the routinely used clinical Society of Thoracic Surgeons score (AUC, 0.758; 95% CI, 0.671-0.845). Depressed right ventricular ejection fraction, as identified on echocardiography, was associated with mortality within 1 year after TAVR ( = 0.034), further corroborating the CT findings.
Features related to right heart failure on pre-TAVR CT were associated with increased all-cause mortality within the first year after TAVR, even after adjustment for the Society of Thoracic Surgeons score. Such imaging findings can help in further risk stratification of patients before TAVR.
本研究旨在确定经导管主动脉瓣置换术（TAVR）前 CT 上观察到的右心衰竭影像学特征是否预测术后不良结局。
我们回顾性评估了 2014 年至 2018 年间连续 505 例接受 TAVR 的患者的 CT 检查结果。其中 300 例接受了 TAVR。记录患者的人口统计学特征、临床和手术数据。评估了影像学特征，包括右心衰竭、左心衰竭、肺部疾病、冠状动脉疾病以及二尖瓣和器械钙化的征象。主要结局是 TAVR 后 1 年内的全因死亡率。将患者分为两组：TAVR 后 1 年内存活（组 1）和死亡（组 2）的患者。当适用时，使用 Mann-Whitney U 检验、Pearson 卡方和 Fisher 确切概率检验对这些组进行比较。使用向后逐步法进行多变量逻辑回归。结果与超声心动图结果相关。
共有 31 例（10.3%）患者在 TAVR 后 1 年内死亡。心包积液的存在和大小与 TAVR 后 1 年内的死亡率密切相关（ = 0.002）。在组 1中有 25 例（9.3%）患者和组 2 中有 8 例（25.8%）患者存在心包积液。主肺动脉增大与死亡相关（ = 0.024），组 1 的主肺动脉大小中位数为 2.9cm（四分位距，2.6-3.3cm），组 2 为 3.2cm（四分位距，2.9-3.5cm）。多变量分析显示，心包积液大小和肺动脉大小（均提示右心衰竭）是死亡的预测因素，独立于常规使用的胸外科医生协会评分（AUC，0.758；95%CI，0.671-0.845）。超声心动图检查发现右心室射血分数降低与 TAVR 后 1 年内的死亡率相关（ = 0.034），进一步证实了 CT 检查结果。
TAVR 前 CT 上与右心衰竭相关的特征与 TAVR 后 1 年内的全因死亡率增加相关，即使在调整胸外科医生协会评分后也是如此。这些影像学发现有助于在 TAVR 前进一步对患者进行危险分层。
