Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany.
Eur J Radiol. 2022 Apr;149:110212. doi: 10.1016/j.ejrad.2022.110212. Epub 2022 Feb 14.
To investigate the predictive value of right ventricular long axis strain (RV-LAS) derived by cardiac computed tomography angiography (CCTA) for mortality in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
We retrospectively included patients with severe AS undergoing TAVR (n = 168, median 79 years). Parameters of RV function including RV-LAS and RV ejection fraction (RVEF) were assessed using pre-procedural systolic and diastolic CCTA series. The tricuspid annulus diameter (TAD) and diameter of the main pulmonary artery (mPA) were also assessed. All-cause mortality was recorded post-TAVR. Cox regression was used and results are presented with hazard ratio (HR) and 95% confidence interval (CI). Harrell's c-index was used to assess the performance of different models and the likelihood ratio test was used to compare nested models.
Thirty-eight deaths (22.6%) occurred over a median follow-up of 21 months. RV-LAS > -11.42% (HR 2.86, 95% CI 1.44-5.67, p = 0.003), LVEF (HR 0.98, 95% CI 0.96-0.996; p = 0.02), TAD (HR 1.05, 95% CI 1.01-1.10, p = 0.02) and mPA diameter (HR 1.09, 95% CI 1.02-1.16, p = 0.01) were associated with mortality on univariable analysis. In a multivariable model, only RV-LAS (HR 2.36, 95% CI 1.04-5.36, p = 0.04) remained as an independent predictor of all-cause mortality. RV-LAS significantly improved the predictive power of the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (c-index 0.700 vs 0.637; p = 0.01).
RV-LAS was an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR, outperformed anatomical markers such as TAD and mPA diameter, and could potentially improve the current risk-stratifying tool.
通过心脏 CT 血管造影（CCTA）评估右心室长轴应变（RV-LAS）对接受经导管主动脉瓣置换术（TAVR）的主动脉瓣狭窄（AS）患者死亡率的预测价值。
我们回顾性纳入了 168 例接受 TAVR 的严重 AS 患者（中位年龄 79 岁）。使用术前收缩期和舒张期 CCTA 系列评估 RV 功能参数，包括 RV-LAS 和 RV 射血分数（RVEF）。还评估了三尖瓣环直径（TAD）和主肺动脉直径（mPA）。记录 TAVR 后的全因死亡率。使用 Cox 回归，并以风险比（HR）和 95%置信区间（CI）表示结果。使用 Harrell's c 指数评估不同模型的性能，并使用似然比检验比较嵌套模型。
中位随访 21 个月期间，38 例患者（22.6%）死亡。RV-LAS > -11.42%（HR 2.86，95%CI 1.44-5.67，p=0.003）、LVEF（HR 0.98，95%CI 0.96-0.996；p=0.02）、TAD（HR 1.05，95%CI 1.01-1.10，p=0.02）和 mPA 直径（HR 1.09，95%CI 1.02-1.16，p=0.01）与单变量分析中的死亡率相关。在多变量模型中，只有 RV-LAS（HR 2.36，95%CI 1.04-5.36，p=0.04）仍然是全因死亡率的独立预测因子。RV-LAS 显著提高了胸外科医师协会预测死亡率风险评分（STS-PROM）（c 指数 0.700 与 0.637；p=0.01）的预测能力。
RV-LAS 是接受 TAVR 的严重 AS 患者全因死亡率的独立预测因子，优于 TAD 和 mPA 直径等解剖学标志物，可能改善目前的风险分层工具。
