Lin Cheng Ting, Czarny Matthew J, Hussien Amira, Hasan Rani K, Garibaldi Brian T, Fishman Elliot K, Resar Jon R, Zimmerman Stefan Loy
Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287.
Radiol Cardiothorac Imaging. 2020 Apr 30;2(2):e190093. doi: 10.1148/ryct.2020190093. eCollection 2020 Apr.
To evaluate the relationship between CT findings of diffuse lung disease and post-transcatheter aortic valve replacement (TAVR) outcomes.
Retrospective review of pre-TAVR CT scans obtained during 2012-2017 was conducted. Emphysema, reticulation, and honeycombing were separately scored using a five-point scale and applied to 10 images per examination. The fibrosis score was the sum of reticulation and honeycombing scores. Lung diseases were also assessed as dichotomous variables (zero vs nonzero scores). The two outcomes evaluated were death and the composite of death and readmission.
The study included 373 patients with median age of 84 years (age range, 51-98 years; interquartile range, 79-88 years) and median follow-up of 333 days. Fibrosis and emphysema were present in 66 (17.7%) and 95 (25.5%) patients, respectively. Fibrosis as a dichotomous variable was independently associated with the composite of death and readmission (hazard ratio [HR], 1.54; = .030). In those without known chronic lung disease (CLD) (HR, 3.09; = .024) and those without airway obstruction, defined by a ratio of forced expiratory volume in 1 second to the forced vital capacity greater than or equal to 70% (HR, 1.67, = .039), CT evidence of fibrosis was a powerful predictor of adverse events. Neither emphysema score nor emphysema as a dichotomous variable was an independent predictor of outcome.
The presence of fibrosis on baseline CT scans was an independent predictor of adverse events after TAVR. In particular, fibrosis had improved predictive value in both patients without known CLD and patients without airway obstruction..© RSNA, 2020.
评估弥漫性肺疾病的CT表现与经导管主动脉瓣置换术（TAVR）术后结果之间的关系。
对2012年至2017年期间获取的TAVR术前CT扫描进行回顾性分析。肺气肿、网状改变和蜂窝状改变分别采用五分制评分，并应用于每次检查的10幅图像。纤维化评分是网状改变和蜂窝状改变评分之和。肺部疾病也被评估为二分变量（评分为零与非零）。评估的两个结果是死亡以及死亡和再入院的综合情况。
该研究纳入了373例患者，中位年龄为84岁（年龄范围51 - 98岁；四分位间距79 - 88岁），中位随访时间为333天。分别有66例（17.7%）和95例（25.5%）患者存在纤维化和肺气肿。纤维化作为二分变量与死亡和再入院的综合情况独立相关（风险比[HR]，1.54；P = 0.030）。在无已知慢性肺病（CLD）的患者中（HR，3.09；P = 0.024）以及在无气道阻塞（定义为1秒用力呼气容积与用力肺活量之比大于或等于70%）的患者中（HR，1.67，P = 0.039），CT显示的纤维化是不良事件的有力预测指标。肺气肿评分以及肺气肿作为二分变量均不是结果的独立预测指标。
基线CT扫描显示存在纤维化是TAVR术后不良事件的独立预测指标。特别是，纤维化在无已知CLD的患者和无气道阻塞的患者中具有更高的预测价值。©RSNA，2020。
