Ko Kinsing, Zwetsloot Peter-Paul, Voskuil Michiel, Stella Pieter, Leiner Tim, Kraaijeveld Adriaan
Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
J Invasive Cardiol. 2022 Mar;34(3):E218-E225. doi: 10.25270/jic/21.00161.
The transcatheter aortic valve implantation (TAVI) population is mostly elderly and frail. Clinically significant incidental findings (SIFs) are commonly encountered in the work-up of TAVI patients. This is a systematic review of current literature on the occurrence of SIFs on computed tomography (CT) imaging preceding TAVI and their association with mortality, delayed planning, and procedure cancellation.
A systematic search on Medline, Embase, and Cochrane resulted in 19 retrospective studies (published from 2010-2020) reporting SIFs in the work-up for TAVI. A total of 6358 individuals from 19 studies were analyzed, with mean age of 80 years and sex equally divided. A random-effects meta-analysis was performed, with weighting based on study size.
Pooled prevalence of patients with SIF was 22.2% (95% confidence interval [CI], 17.8-26.6) and most findings (48.3%) were found in the lungs. Pooled prevalence of new malignancies was 3.4% (95% CI, 2.5-4.4). Higher mortality in patients with SIF was only found in studies with a follow-up period >4 years (hazard ratio, 1.5-1.7). TAVI was more frequently cancelled in patients with SIF vs those with no SIF (ranges, 10.1%-47.1% vs 5.2%-37.0%, respectively). SIF did not delay time to TAVI (ranges, 6-91 days in SIF patients vs 4-81 days in non-SIF patients).
SIFs are common in patients screened for TAVI. SIF is associated with a higher risk of TAVI cancellation and with increased mortality risk over the long term, which should be taken into consideration in decision making. These findings may help inform patients and aid patient selection.
经导管主动脉瓣植入术（TAVI）的患者大多为老年人且身体虚弱。在TAVI患者的检查过程中，经常会遇到具有临床意义的偶然发现（SIFs）。这是一项对当前文献的系统综述，内容涉及TAVI术前计算机断层扫描（CT）成像中SIFs的发生情况及其与死亡率、延迟手术规划和手术取消的关联。
对Medline、Embase和Cochrane进行系统检索，得到19项回顾性研究（发表于2010年至2020年），报告了TAVI检查中的SIFs。对19项研究中的6358名个体进行了分析，平均年龄为80岁，男女比例均等。进行了随机效应荟萃分析，并根据研究规模进行加权。
SIF患者的合并患病率为22.2%（95%置信区间[CI]，17.8 - 26.6），大多数发现（48.3%）位于肺部。新恶性肿瘤的合并患病率为3.4%（95% CI，2.5 - 4.4）。仅在随访期>4年的研究中发现SIF患者的死亡率较高（风险比，1.5 - 1.7）。与无SIF的患者相比，SIF患者的TAVI手术更频繁地被取消（范围分别为10.1% - 47.1%和5.2% - 37.0%）。SIF并未延迟TAVI的手术时间（SIF患者为6 - 91天，非SIF患者为4 - 81天）。
SIFs在接受TAVI筛查的患者中很常见。SIF与TAVI手术取消风险较高以及长期死亡率增加相关，在决策时应予以考虑。这些发现可能有助于告知患者并辅助患者选择。
