Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
J Cardiovasc Comput Tomogr. 2021 Sep-Oct;15(5):431-440. doi: 10.1016/j.jcct.2021.03.004. Epub 2021 Mar 21.
Identifying high-risk patients who will not derive substantial survival benefit from TAVR remains challenging. Pulmonary hypertension is a known predictor of poor outcome in patients undergoing TAVR and correlates strongly with pulmonary artery (PA) enlargement on CTA. We sought to evaluate whether PA enlargement, measured on pre-procedural computed tomography angiography (CTA), is associated with 1-year mortality in patients undergoing TAVR.
We retrospectively included 402 patients undergoing TAVR between July 2012 and March 2016. Clinical parameters, including Society of Thoracic Surgeons (STS) score and right ventricular systolic pressure (RVSP) estimated by transthoracic echocardiography were reviewed. PA dimensions were measured on pre-procedural CTAs. Association between PA enlargement and 1-year mortality was analyzed. Kaplan-Meier and Cox proportional hazards regression analyses were performed.
The median follow-up time was 433 (interquartiles 339-797) days. A total of 56/402 (14%) patients died within 1 year after TAVR. Main PA area (area-MPA) was independently associated with 1-year mortality (hazard ratio per standard deviation equal to 2.04 [95%-confidence interval (CI) 1.48-2.76], p < 0.001). Area under the curve (95%-CI) of the clinical multivariable model including STS-score and RVSP increased slightly from 0.67 (0.59-0.75) to 0.72 (0.72-0.89), p = 0.346 by adding area-MPA. Although the AUC increased, differences were not significant (p = 0.346). Kaplan-Meier analysis showed that mortality was significantly higher in patients with a pre-procedural non-indexed area-MPA of ≥7.40 cm compared to patients with a smaller area-MPA (mortality 23% vs. 9%; p < 0.001).
Enlargement of MPA on pre-procedural CTA is independently associated with 1-year mortality after TAVR.
识别不能从 TAVR 中获得实质性生存获益的高危患者仍然具有挑战性。肺动脉高压是 TAVR 患者预后不良的已知预测因素，并且与 CTA 上的肺动脉（PA）扩张密切相关。我们试图评估 TAVR 术前 CT 血管造影（CTA）上测量的 PA 扩张是否与患者 1 年死亡率相关。
我们回顾性纳入 2012 年 7 月至 2016 年 3 月期间接受 TAVR 的 402 例患者。回顾了临床参数，包括胸外科医师协会（STS）评分和经胸超声心动图估计的右心室收缩压（RVSP）。在术前 CTA 上测量 PA 尺寸。分析 PA 扩张与 1 年死亡率之间的关系。进行 Kaplan-Meier 和 Cox 比例风险回归分析。
中位随访时间为 433（四分位距 339-797）天。TAVR 后 1 年内共有 56/402（14%）例患者死亡。主肺动脉面积（area-MPA）与 1 年死亡率独立相关（每标准差的危险比等于 2.04[95%-置信区间（CI）1.48-2.76]，p<0.001）。包括 STS 评分和 RVSP 的临床多变量模型的曲线下面积（95%-CI）略有增加，从 0.67（0.59-0.75）增加到 0.72（0.72-0.89），p=0.346 通过添加 area-MPA。虽然 AUC 增加，但差异无统计学意义（p=0.346）。Kaplan-Meier 分析显示，与较小的 area-MPA 相比，术前非指数 area-MPA 为≥7.40cm 的患者死亡率明显更高（死亡率为 23%比 9%；p<0.001）。
TAVR 术前 CTA 上的 MPA 扩张与 1 年死亡率独立相关。
