Willemink Martin J, Maret Eva, Moneghetti Kegan J, Kim Juyong Brian, Haddad Francois, Kobayashi Yukari, Nishi Takeshi, Nieman Koen, Cauwenberghs Nicholas, Kuznetsova Tatiana, Higashigaito Kai, Sailer Anna M, Yeung Alan C, Lee Anson M, Miller D Craig, Fischbein Michael, Fearon William F, Fleischmann Dominik
Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.).
Radiol Cardiothorac Imaging. 2019 Dec 19;1(5):e190067. doi: 10.1148/ryct.2019190067. eCollection 2019 Dec.
To investigate the association of aortomitral continuity calcification (AMCC) with all-cause mortality, postprocedural paravalvular leak (PVL), and prolonged hospital stay in patients undergoing transcatheter aortic valve replacement (TAVR).
The authors retrospectively evaluated 329 patients who underwent TAVR between March 2013 and March 2016. AMCC, aortic valve calcification (AVC), and coronary artery calcification (CAC) were quantified by using preprocedural CT. Pre-procedural Society of Thoracic Surgeons (STS) score was recorded. Associations between baseline AMCC, AVC, and CAC and 1-year mortality, PVL, and hospital stay longer than 7 days were analyzed.
The median follow-up was 415 days (interquartiles, 344-727 days). After 1 year, 46 of the 329 patients (14%) died and 52 (16%) were hospitalized for more than 7 days. Of the 326 patients who underwent postprocedural echocardiography, 147 (45%) had postprocedural PVL. The CAC score (hazard ratio: 1.11 per 500 points) and AMCC mass (hazard ratio: 1.13 per 500 mg) were associated with 1-year mortality. AVC mass (odds ratio: 1.93 per 100 mg) was associated with postprocedural PVL. Only the STS score was associated with prolonged hospital stay (odds ratio: 1.19 per point).
AMCC is associated with mortality within 1 year after TAVR and substantially improves individual risk classification when added to a model consisting of STS score and AVC mass only.© RSNA, 2019See also the commentary by Brown and Leipsic in this issue.
探讨主动脉二尖瓣连续性钙化（AMCC）与经导管主动脉瓣置换术（TAVR）患者全因死亡率、术后瓣周漏（PVL）及住院时间延长之间的关系。
作者回顾性评估了2013年3月至2016年3月期间接受TAVR的329例患者。采用术前CT对AMCC、主动脉瓣钙化（AVC）和冠状动脉钙化（CAC）进行定量分析。记录术前胸外科医师协会（STS）评分。分析基线AMCC、AVC和CAC与1年死亡率、PVL及住院时间超过7天之间的关系。
中位随访时间为415天（四分位数间距，344 - 727天）。1年后，329例患者中有46例（14%）死亡，52例（16%）住院时间超过7天。在326例行术后超声心动图检查的患者中，147例（45%）出现术后PVL。CAC评分（风险比：每500分1.11）和AMCC质量（风险比：每500 mg 1.13）与1年死亡率相关。AVC质量（比值比：每100 mg 1.93）与术后PVL相关。只有STS评分与住院时间延长相关（比值比：每分1.19）。
AMCC与TAVR术后1年内的死亡率相关，并且当仅添加到由STS评分和AVC质量组成的模型中时，可显著改善个体风险分类。© RSNA，2019另见本期Brown和Leipsic的评论。
