Salavitabar Arash, Boe Brian A, Berman Darren P, Harrison Andrew, Swinning Jason, Baptista Kristine, Eisner Mariah, Bai Shasha, Armstrong Aimee K
Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, Columbus, OH, 43205, USA.
Children's Hospital Los Angeles, Los Angeles, CA, USA.
Pediatr Cardiol. 2023 Jan;44(1):132-140. doi: 10.1007/s00246-022-02994-x. Epub 2022 Aug 27.
The aim of the study was to determine the variables associated with high-quality (HQ) versus low-quality (LQ) three-dimensional rotational angiography (3DRA) and create guides for optimization of approach to 3DRA in congenital cardiac catheterization (CCC). CCC has adopted 3DRA as a mainstay, but there has not been systematic analysis of approach to and factors associated with HQ 3DRA. This was a single-center, retrospective study of 3DRAs using Canon Infinix-I platform. Reconstructions were graded by 3 interventionalists. Quality was dichotomized into HQ and LQ. Univariable analyses and multivariable logistic regression models were performed. From 8/2016 to 12/2018, 208 3DRAs were performed in 195 CCCs; median age 7 years (2, 16), weight 23 kg (12, 57). The majority of 3DRAs were performed in patients with biventricular physiology (N = 137, 66%) and in pulsatile sites (N = 144, 69%). HQ 3DRA (N = 182, 88%) was associated with greater total injection volume [2.20 mL/kg (1.44, 3.29) vs. 1.62 mL/kg (1.10, 1.98), p = 0.005] and more dilute contrast solution [60% (50, 100) vs. 100% (60, 100), p = 0.007], but not with contrast volume administered (p = 0.2) on univariable analysis. On multivariable logistic regression, HQ 3DRA was significantly associated with patient weight [OR 0.97 (95% CI (0.94, 0.99), p = 0.018], total injection volume [OR 1.04 (95% CI 1.01, 1.07) p = 0.011], and percent contrast solution [OR 0.97 (95% CI 0.95, 1.00), p = 0.022]. These data resulted in creation of scatter plots and a novel 3DRA Nomogram for estimating the probability of HQ 3DRA. This is the first study to create evidence-based contrast dose guides and nomogram for 3DRA in CCC. HQ 3DRA was associated with lower weight, higher total injection volumes, and more dilute contrast solution.
本研究的目的是确定与高质量（HQ）和低质量（LQ）三维旋转血管造影（3DRA）相关的变量，并制定在先天性心脏病导管插入术（CCC）中优化3DRA方法的指南。CCC已将3DRA作为主要手段，但尚未对HQ 3DRA的方法及相关因素进行系统分析。这是一项使用佳能Infinix-I平台对3DRA进行的单中心回顾性研究。由3名介入医生对重建图像进行分级。质量分为HQ和LQ两类。进行了单变量分析和多变量逻辑回归模型分析。从2016年8月至2018年12月，在195例CCC中进行了208次3DRA；中位年龄7岁（2，16），体重23千克（12，57）。大多数3DRA是在双心室生理状态的患者中进行的（N = 137，66%），且在搏动部位（N = 144，69%）。HQ 3DRA（N = 182，88%）与更大的总注射量[2.20毫升/千克（1.44，3.29） vs. 1.62毫升/千克（1.10，1.98），p = 0.005]和更稀释的造影剂溶液[60%（50，100） vs. 100%（60，100），p = 0.007]相关，但在单变量分析中与给予的造影剂体积无关（p = 0.2）。在多变量逻辑回归中，HQ 3DRA与患者体重[比值比0.97（95%可信区间（0.94，0.99），p = 0.018]、总注射量[比值比1.04（95%可信区间1.01，1.07），p = 0.011]和造影剂溶液百分比[比值比0.97（95%可信区间0.95，1.00），p = 0.022]显著相关。这些数据生成了散点图和一个用于估计HQ 3DRA概率的新型3DRA列线图。这是第一项为CCC中的3DRA创建基于证据的造影剂剂量指南和列线图的研究。HQ 3DRA与较低体重、较高总注射量和更稀释的造影剂溶液相关。
