经导管主动脉瓣置换术治疗的重度主动脉瓣狭窄患者中，肺动脉顺应性降低可预测持续性肺动脉高压和 2 年死亡率。
Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR.
机构信息
Department of Radiology, Stanford University School of Medicine, MC:5659, 453 Quarry Road, Stanford, CA, 94304.
Department of Radiology, Stanford University School of Medicine, MC:5659, 453 Quarry Road, Stanford, CA, 94304; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
出版信息
Acad Radiol. 2023 Dec;30(12):2825-2833. doi: 10.1016/j.acra.2023.03.014. Epub 2023 May 4.
RATIONALE AND OBJECTIVES
Post-TAVR persistent pulmonary hypertension (PH) is a better predictor of poor outcome than pre-TAVR PH. In this longitudinal study we sought to evaluate whether pulmonary artery (distensibility (D) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR.
MATERIALS AND METHODS
Three hundred and thirty-six patients undergoing TAVR between July 2012 and March 2016 were retrospectively included and followed for all-cause mortality until November 2017. All patients underwent retrospectively ECG-gated CTA prior to TAVR. Main pulmonary artery (MPA) area was measured in systole and in diastole. D was calculated as: [(area-MPA-area-MPA)/area-MPA]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of D for persistent-PH. Two groups were compared based on a D threshold of 8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard, and logistic regression analyses were performed. The primary clinical endpoint was defined as persistent-PH post-TAVR. The secondary endpoint was defined as all-cause mortality 2 years after TAVR.
RESULTS
Median follow-up time was 413 (interquartiles 339-757) days. A total of 183 (54%) had persistent-PH and 68 (20%) patients died within 2-years after TAVR. Patients with D<8% had significantly more persistent-PH (67% vs 47%, p<0.001) and 2-year deaths (28% vs 15%, p=0.006), compared to patients with D>8%. Adjusted multivariable regression analyses showed that D<8% was independently associated with persistent-PH (OR 2.10 [95%-CI 1.3-4.5], p=0.007) and 2-year mortality (HR 2.91 [95%-CI 1.5-5.8], p=0.002). Kaplan-Meier analysis showed that 2-year mortality of patients with D<8% was significantly higher compared to patients with D≥8% (mortality 28% vs 15%; log-rank p=0.003).
CONCLUSION
D on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR.
背景与目的
经导管主动脉瓣置换术（TAVR）后持续性肺动脉高压（PH）比术前 PH 更能预测不良预后。在这项纵向研究中，我们旨在评估 TAVR 术前心电图门控 CT 血管造影（CTA）测量的肺动脉（顺应性（D）是否与 TAVR 后持续性 PH 和 2 年死亡率相关。
材料与方法
回顾性纳入 2012 年 7 月至 2016 年 3 月期间接受 TAVR 的 336 例患者，并随访至 2017 年 11 月的全因死亡率。所有患者在 TAVR 前均接受回顾性心电图门控 CTA。测量主肺动脉（MPA）在收缩期和舒张期的面积。D 计算为：[(面积-MPA 面积-MPA)/面积-MPA]%。进行 ROC 分析以评估持续性 PH 的 AUC。采用 Youden 指数确定 D 预测持续性 PH 的最佳阈值。根据 D 阈值为 8%（预测持续性 PH 的特异性为 70%）将两组进行比较。进行 Kaplan-Meier、Cox 比例风险和逻辑回归分析。主要临床终点定义为 TAVR 后持续性 PH。次要终点定义为 TAVR 后 2 年内的全因死亡率。
结果
中位随访时间为 413（四分位间距 339-757）天。共有 183 例（54%）存在持续性 PH，68 例（20%）患者在 TAVR 后 2 年内死亡。D<8%的患者持续性 PH（67%比 47%，p<0.001）和 2 年死亡率（28%比 15%，p=0.006）显著更高，与 D>8%的患者相比。多变量调整回归分析显示，D<8%与持续性 PH（OR 2.10[95%CI 1.3-4.5]，p=0.007）和 2 年死亡率（HR 2.91[95%CI 1.5-5.8]，p=0.002）独立相关。Kaplan-Meier 分析显示，D<8%的患者 2 年死亡率明显高于 D≥8%的患者（死亡率 28%比 15%；log-rank p=0.003）。
结论
TAVR 患者术前 CTA 上的 D 与持续性 PH 和 2 年死亡率独立相关。
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