Hein Manuel, Breitbart Philipp, Minners Jan, Blanke Philipp, Schoechlin Simon, Schlett Christopher, Krauss Tobias, Soschynski Martin, Neumann Franz-Josef, Ruile Philipp
Department of Cardiology & Angiology II, University Heart Center Freiburg, 79106 Freiburg, Germany.
Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC V6Z1Y6, Canada.
J Clin Med. 2022 Mar 25;11(7):1817. doi: 10.3390/jcm11071817.
(1) Background: Early hypo-attenuated leaflet thickening (HALT) is diagnosed by computed tomography angiography (CTA) in approximately 15% of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to investigate the diagnostic performance of CTA for the diagnosis of HALT, focusing on timing data assessment within the cardiac cycle. (2) Methods: The study enrolled 50 patients with and 50 without HALT with available post-TAVR-CTA. The primary objective was to compare the diagnostic performance of CTA readings at specific intervals and time points during the cardiac cycle (entire systole, entire diastole, end-systole, and mid-diastole) versus gold standard (consensus reading by two observers based on multiphase full cardiac cycle data sets). (3) Results: 100 CTAs were independently analysed by two observers blinded to clinical characteristics of the study population and the results from the gold standard reading. Sensitivity and specificity for the diagnosis of HALT were 84%/94% in systole, 87%/92% in diastole, 78%/95% at end-systole, and 80%/94% at mid-diastole. End-systole had the highest positive predictive value (0.88) and positive likelihood ratio (36). Cohen's kappa for interobserver reliability was 0.715 in systole, 0.578 in diastole, 0.650 at end-systole, and 0.517 at mid-diastole. (4) Conclusion: Limiting CTA reading to distinct intervals or time points during the cardiac cycle has good specificity but lowers sensitivity. For a reliable diagnosis of HALT, data sets from a multiphase CTA covering the entire cardiac cycle should be analysed. A double reader approach would be desirable in further studies investigating HALT.
（1）背景：在接受经导管主动脉瓣置换术（TAVR）的患者中，约15%可通过计算机断层扫描血管造影（CTA）诊断出早期小叶低密度增厚（HALT）。我们旨在研究CTA对HALT的诊断性能，重点关注心动周期内的时间数据评估。（2）方法：该研究纳入了50例有HALT和50例无HALT且有TAVR术后CTA资料的患者。主要目的是比较心动周期特定间隔和时间点（整个收缩期、整个舒张期、收缩末期和舒张中期）的CTA读数与金标准（两名观察者基于多期全心动周期数据集的一致性读数）的诊断性能。（3）结果：两名对研究人群临床特征和金标准读数结果不知情的观察者对100份CTA进行了独立分析。收缩期诊断HALT的敏感性和特异性分别为84%/94%，舒张期为87%/92%，收缩末期为78%/95%，舒张中期为80%/94%。收缩末期的阳性预测值最高（0.88），阳性似然比最高（36）。观察者间可靠性的Cohen's kappa系数在收缩期为0.715，舒张期为0.578，收缩末期为0.650，舒张中期为0.517。（4）结论：将CTA读数限制在心动周期的特定间隔或时间点具有良好的特异性，但会降低敏感性。为可靠诊断HALT，应分析覆盖整个心动周期的多期CTA数据集。在进一步研究HALT时，采用双观察者方法较为理想。
