经导管主动脉瓣植入术后特征追踪计算机断层扫描左心房应变与长期生存
Feature-tracking computed tomography left atrial strain and long-term survival after transcatheter aortic valve implantation.
作者信息
Hirasawa Kensuke, Singh Gurpreet K, Kuneman Jurrien H, Gegenava Tea, van der Kley Frank, Hautemann David, Reiber Johan H C, Ajmone Marsan Nina, Bax Jeroen J, Delgado Victoria
机构信息
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
TestDynamics EU B.V, 2665 CZ Bleiswijk, The Netherlands.
出版信息
Eur Heart J Cardiovasc Imaging. 2023 Feb 17;24(3):327-335. doi: 10.1093/ehjci/jeac157.
AIMS
Aortic stenosis (AS) induces left atrial (LA) remodelling through the increase of left ventricular (LV) filling pressures. Peak LA longitudinal strain (PALS), reflecting LA reservoir function, has been proposed as a prognostic marker in patients with AS. Feature-tracking (FT) multi-detector computed tomography (MDCT) allows assessment of LA strain from MDCT data. The aim of this study is to investigate the association between PALS using FT MDCT and survival in patients with severe AS who underwent transcatheter aortic valve implantation (TAVI).
METHODS AND RESULTS
A total of 376 patients (mean age 80 ± 7 years, 53% male) who underwent MDCT before TAVI and had suitable data for assessment of PALS using dedicated FT software, were included. The patients were classified into four groups according to PALS quartiles; PALS > 19.3% (Q1, highest reservoir function), 15.0-19.3% (Q2), 9.1-14.9% (Q3), and ≤9.0% (Q4, lowest reservoir function). The primary outcome was all-cause mortality. During a median of 45 (22-68) months follow-up, 148 patients (39%) died. On multivariable Cox regression analysis, PALS was independently associated with all-cause mortality [hazard ratio (HR): 1.044, 95% confidence interval (CI): 1.012-1.076, P = 0.006]. Compared with patients in Q1, patients in Q3 and Q4 were associated with higher risk of mortality after TAVI [HR: 2.262 (95% CI: 1.335-3.832), P = 0.002 for Q3, HR: 3.116 (95% CI: 1.864-5.210), P < 0.001 for Q4].
CONCLUSION
PALS assessed with FT MDCT is independently associated with all-cause mortality after TAVI.
目的
主动脉瓣狭窄（AS）通过增加左心室（LV）充盈压诱导左心房（LA）重塑。反映LA储备功能的LA纵向应变峰值（PALS）已被提议作为AS患者的预后标志物。特征追踪（FT）多层螺旋计算机断层扫描（MDCT）可从MDCT数据评估LA应变。本研究的目的是探讨使用FT MDCT测量的PALS与接受经导管主动脉瓣植入术（TAVI）的重度AS患者生存率之间的关联。
方法与结果
共有376例患者（平均年龄80±7岁，53%为男性）在TAVI术前接受了MDCT检查，且有适合使用专用FT软件评估PALS的数据。根据PALS四分位数将患者分为四组：PALS>19.3%（Q1，储备功能最高）、15.0 - 19.3%（Q2）、9.1 - 14.9%（Q3）和≤9.0%（Q4，储备功能最低）。主要结局是全因死亡率。在中位45（22 - 68）个月的随访期间，148例患者（39%）死亡。多变量Cox回归分析显示，PALS与全因死亡率独立相关[风险比（HR）：1.044，95%置信区间（CI）：1.012 - 1.076，P = 0.006]。与Q1组患者相比，Q3组和Q4组患者TAVI术后死亡风险更高[Q3组HR：2.262（95% CI：1.335 - 3.832），P = 0.002；Q4组HR：3.116（95% CI：1.864 - 5.210），P < 0.001]。
结论
通过FT MDCT评估的PALS与TAVI术后全因死亡率独立相关。
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