计算机断层扫描得出的肺动脉直径测量值对经导管主动脉瓣置换术后长期预后的预测价值
Prognostic value of computed tomography derived measurements of pulmonary artery diameter for long-term outcomes after transcatheter aortic valve replacement.
作者信息
Kalińczuk Łukasz, Chmielak Zbigniew, Dąbrowski Maciej, Mazurkiewicz Marcin, Stokłosa Patrycjusz, Skotarczak Wiktor, Mintz Gary S, Wolny Rafał, Tyczyński Paweł, Konka Marek, Michałowska Anna, Kowalik Ilona, Demkow Marcin, Michałowska Ilona, Witkowski Adam
机构信息
Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warszawa, Poland.
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland.
出版信息
Kardiol Pol. 2022;80(10):1020-1026. doi: 10.33963/KP.a2022.0173. Epub 2022 Jul 27.
BACKGROUND
An increase in pulmonary artery diameter (PAD) on multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of PAD on outcomes after successful transcatheter aortic valve replacement (TAVR).
METHODS
Consecutive patients treated with TAVR from February 2013 to October 2017, with a 68.8% rate of new generation valves, underwent pre-interventional MDCT with measurements of PAD (in the widest short-axis within 3 cm of the bifurcation) and ascending aortic diameter (AoD; at the level of the PAD). The PAD/AoD ratio was calculated. Patients with high-density lipoprotein cholesterol levels ≤46 mg/dl and C-reactive protein levels ≥0.20 mg/dl at baseline were identified as the frail group. One-year mortality was established for all subjects.
RESULTS
Among studied 266 patients (median age, 82.0 years; 63.5% women) those who died at 1 year (n = 34; 12.8%) had larger PAD and PAD/AoD (28.9 [5.0] vs. 26.5 [4.6] mm and 0.81 [0.13] vs. 0.76 [0.13] mm vs. the rest of the studied subjects; P = 0.005 and P = 0.02, respectively) but similar AoD. The cutoff value for the PAD to predict 1-year mortality was 29.3 mm (sensitivity, 50%; specificity, 77%; area under the curve, 0.65). Patients with PAD >29.3 mm (n = 72; 27%) had higher 1-year mortality (23.6% vs. 8.8%, log-rank P = 0.001). Baseline characteristics associated with PAD29.3 mm were a bigger body mass index, more frequent diabetes mellitus, more prior stroke/transient ischemic attacks and atrial fibrillation, and lower baseline maximal aortic valve gradient with higher pulmonary artery systolic pressure (PASP). PAD >29.3 mm and frailty, but not baseline PASP, remained predictive of 1-year mortality in the multivariable model (hazard ratio [HR], 2.221; 95%CI, 1.038-4.753; P = 0.04 and HR, 2.801; 95% CI, 1.328-5.910; P = 0.007, respectively).
CONCLUSION
PAD >29.3 mm on baseline MDCT is associated with higher 1-year mortality after TAVR, independently of echocardiographic measures of PH and frailty.
背景
多排螺旋计算机断层扫描（MDCT）显示的肺动脉直径（PAD）增加可能提示肺动脉高压。我们评估了MDCT测量的PAD对成功经导管主动脉瓣置换术（TAVR）后结局的预后价值。
方法
连续纳入2013年2月至2017年10月接受TAVR治疗的患者，其中新一代瓣膜使用率为68.8%，术前行MDCT检查，测量PAD（在分叉处3 cm内最宽短轴处）和升主动脉直径（AoD；在PAD水平）。计算PAD/AoD比值。将基线时高密度脂蛋白胆固醇水平≤46 mg/dl且C反应蛋白水平≥0.20 mg/dl的患者确定为虚弱组。确定所有受试者的1年死亡率。
结果
在研究的266例患者（中位年龄82.0岁；63.5%为女性）中，1年时死亡的患者（n = 34；12.8%）的PAD和PAD/AoD更大（分别为28.9 [5.0] vs. 26.5 [4.6] mm和0.81 [0.13] vs. 0.76 [0.13]，与其余研究对象相比；P = 0.005和P = 0.02），但AoD相似。预测1年死亡率的PAD临界值为29.3 mm（敏感性50%；特异性77%；曲线下面积0.65）。PAD>29.3 mm的患者（n = 72；27%）1年死亡率更高（23.6% vs. 8.8%，对数秩检验P = 0.001）。与PAD>29.3 mm相关的基线特征包括更大的体重指数、更频繁的糖尿病、更多既往中风/短暂性脑缺血发作和心房颤动，以及更低的基线最大主动脉瓣压差和更高的肺动脉收缩压（PASP）。在多变量模型中，PAD>29.3 mm和虚弱，但不是基线PASP，仍然是1年死亡率的预测因素（风险比[HR]，2.221；95%CI，1.038 - 4.753；P = 0.04和HR，2.801；95%CI，1.328 - 5.910；P = 0.007）。
结论
基线MDCT显示PAD>29.3 mm与TAVR后1年死亡率较高相关，独立于肺动脉高压的超声心动图指标和虚弱情况。
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