Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
J Cardiovasc Comput Tomogr. 2022 Mar-Apr;16(2):174-181. doi: 10.1016/j.jcct.2021.10.008. Epub 2021 Oct 30.
In patients with prosthetic heart valves (PHV), there are distinct treatment implications based on prosthetic valve dysfunction (PVD) etiology. We investigated whether evaluation for PVD etiology on computed tomography (CT) has prognostic value for adverse clinical outcomes.
Consecutive patients with suspected PVD that had a clinically indicated contrast chest CT and echocardiogram done within 1 year of each other were identified retrospectively from the Prosthetic Heart Valve CT Registry at the University of Minnesota. CTs and echocardiograms were assessed for potential PVD etiologies of pannus, structural valve degeneration (SVD) and thrombus, as per standard guidelines. Kaplan-Meier and Cox regression analyses were performed to assess association with a composite outcome of reoperation and all-cause mortality.
132 patients (51.5% male, mean age 62.1 ± 19.3 years) with suspected PVD were included. There were 97 tissue valves, 31 mechanical valves and 4 transcatheter valves. The location of the valve was as follows: 72 aortic, 45 mitral, 8 tricuspid, and 7 pulmonic. A PVD etiology was diagnosed on CT in 80 (60.6%) patients, and on echocardiography in 45 (34.1%) patients, largely driven by a diagnosis of SVD on both modalities. Significant univariate predictors of the composite outcome included CT diagnosis of SVD (P < 0.001), echocardiography diagnosis of SVD (P < 0.001), degree of prosthetic stenosis (P < 0.001) and degree of prosthetic regurgitation (P < 0.001). On multivariable analyses adjusted for age, sex, left ventricular function, degree of prosthetic stenosis and degree of prosthetic regurgitation, CT diagnosis of SVD was significantly associated with the composite outcome (HR: 1.79, 1.09-2.95) whereas echocardiography diagnosis of SVD was not (HR: 1.56, 0.98-2.46).
In patients with suspected PVD, CT assessment of SVD had prognostic significance for hard outcomes. CT should be considered in the diagnostic evaluation of patients with suspected PVD.
在人工心脏瓣膜（PHV）患者中，基于人工瓣膜功能障碍（PVD）病因，存在明显的治疗意义。我们研究了 CT 对 PVD 病因的评估对不良临床结局是否具有预后价值。
回顾性地从明尼苏达大学人工心脏瓣膜 CT 注册中心确定了连续患有疑似 PVD 的患者，这些患者在 CT 和超声心动图之间有 1 年的临床指示性对比胸部 CT 和超声心动图。根据标准指南，对 CT 和超声心动图进行评估，以确定 PVD 病因是否为假性肿瘤、结构性瓣膜退化（SVD）和血栓。进行 Kaplan-Meier 和 Cox 回归分析以评估与再手术和全因死亡率复合结局的关联。
132 例疑似 PVD 患者（51.5%男性，平均年龄 62.1±19.3 岁）入选。其中 97 例为组织瓣膜，31 例为机械瓣膜，4 例为经导管瓣膜。瓣膜位置如下：72 例主动脉瓣，45 例二尖瓣，8 例三尖瓣，7 例肺动脉瓣。80 例（60.6%）患者在 CT 上诊断出 PVD 病因，45 例（34.1%）患者在超声心动图上诊断出 PVD 病因，主要是两种模态均诊断为 SVD。复合结局的显著单变量预测因子包括 CT 诊断的 SVD（P<0.001）、超声心动图诊断的 SVD（P<0.001）、人工瓣膜狭窄程度（P<0.001）和人工瓣膜反流程度（P<0.001）。在调整年龄、性别、左心室功能、人工瓣膜狭窄程度和人工瓣膜反流程度后，多变量分析显示 CT 诊断的 SVD 与复合结局显著相关（HR：1.79，1.09-2.95），而超声心动图诊断的 SVD 则无显著相关性（HR：1.56，0.98-2.46）。
在疑似 PVD 的患者中，CT 评估 SVD 对硬终点有预后意义。在疑似 PVD 患者的诊断评估中应考虑 CT。
