Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria.
Department of Cardiology, Johannes Kepler University Hospital Linz, 4020, Linz, Austria.
Clin Res Cardiol. 2023 Oct;112(10):1394-1416. doi: 10.1007/s00392-023-02182-8. Epub 2023 Mar 20.
Transthoracic echocardiography (TTE) offers a measurement method for the determination of pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) with determination of maximal tricuspid regurgitation velocity (TRVmax) and systolic pulmonary artery pressure (sPAP). Radiological parameters for noninvasive detection of PH, most importantly computed tomography (CT) based PA/AA-ratio = ratio of pulmonary artery diameter (PA) and ascending aorta diameter (AA), are also included in the latest ESC guidelines. The aim of the present study was to define cut-off values for PA/AA-ratio taking also into account cardiovascular biomarkers to determine criteria for noninvasive diagnosis of PH.
194 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) underwent pre-procedural TTE and CT with measurement of PA/AA-ratio. Additionally, common cardiovascular biomarkers were determined.
TAVR patients with an sPAP ≥ 40 mmHg or a TRVmax ≥ 2.9 m/s had a PA/AA-ratio ≥ 0.80 in an AUROC analysis. The cut-off value of ≥ 0.80 resulted in a significantly higher mortality rate (log-rank test: p = 0.034) in these patients in a Kaplan-Meier analysis regarding 1-year survival after TAVR. Significant differences in biomarker expression between patients with a PA/AA-ratio ≥ 0.80 or < 0.80 occurred for BNP (p = 0.001), cTnI (p = 0.032), GDF-15 (p = 0.002) and H-FABP (p = 0.015).
PA/AA-ratio ≥ 0.80 is a promising radiological parameter that can provide information about mortality in patients with severe AS undergoing TAVR; combined with biomarkers it may contribute to noninvasive detection of PH in patients with severe AS.
经胸超声心动图（TTE）提供了一种测量方法，用于确定严重主动脉瓣狭窄（AS）患者的肺动脉高压（PH），方法是测量最大三尖瓣反流速度（TRVmax）和收缩期肺动脉压（sPAP）。放射学参数也包含在最新的 ESC 指南中，用于无创检测 PH，最重要的是基于计算机断层扫描（CT）的 PA/AA-比=肺动脉直径（PA）和升主动脉直径（AA）的比值。本研究的目的是确定 PA/AA-比的截止值，同时考虑心血管生物标志物，以确定 PH 无创诊断的标准。
194 例接受经导管主动脉瓣置换术（TAVR）的严重 AS 患者接受了术前 TTE 和 CT 检查，并测量了 PA/AA-比。此外，还测定了常见的心血管生物标志物。
在 AUROC 分析中，sPAP≥40mmHg 或 TRVmax≥2.9m/s 的 TAVR 患者的 PA/AA-比≥0.80。在 Kaplan-Meier 分析中，这些患者的截止值≥0.80导致 TAVR 后 1 年生存率的死亡率显著升高（对数秩检验：p=0.034）。PA/AA-比≥0.80或<0.80的患者之间，BNP（p=0.001）、cTnI（p=0.032）、GDF-15（p=0.002）和 H-FABP（p=0.015）的生物标志物表达存在显著差异。
PA/AA-比≥0.80 是一种很有前途的放射学参数，可提供 TAVR 严重 AS 患者死亡率的信息；与生物标志物结合，可能有助于无创检测严重 AS 患者的 PH。
