非对比心脏计算机断层扫描衍生的二尖瓣环钙化评分在二尖瓣疾病中的应用。
Noncontrast cardiac computed tomography-derived mitral annular calcification scores in mitral valve disease.
机构信息
College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, China.
Department of Radiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
出版信息
Clin Cardiol. 2023 Nov;46(11):1310-1318. doi: 10.1002/clc.24110. Epub 2023 Aug 4.
BACKGROUND AND AIMS
Mitral annular calcification (MAC) by computed tomography (CT) is reported as an independent predictor of poor outcomes. However, it currently remains unclear if quantitative MAC parameters provide more value for mitral valve disease (MVD) management, therefore, we examined the prognostic value of MAC scores using noncontrast cardiac-CT in MVD patients.
METHODS
Between January 2020 and December 2021, we prospectively enrolled 300 consecutive patients with MVD (MAC-present = 80 and MAC-absent = 220) undergoing preoperative cardiac-CT and mitral valve (MV) surgery. Noncontrast cardiac-CT images were used to qualitatively detect MAC (present or absent) and evaluate MAC scores. For analyses, we also collected baseline clinical data, intraoperative conversion (from MV repair to MV replacement), and follow-up arrhythmia data.
RESULTS
Compared with the MAC-absent group, MAC-present patients were older (62 ± 7 vs. 58 ± 9 years, p < .001), mostly women (55% vs. 39.5%, p = .017), and also had aortic valve calcification (57.5% vs. 23.2%, p < .001), mitral stenosis (82.5% vs. 61.8%, p < .001), atrial fibrillation (30% vs. 11.8%, p < .001), and larger left atrial end-diastolic dimension (LADD, 49 [44-56] versus 46 [41-50], p = .001]. Furthermore, MAC-present patients underwent more MV replacements (61.8% vs. 82.5%, p = .001) and experienced a higher intraoperative conversion prevalence (11.8% vs. 61.3%, p < .001). Multiple logistic regression analyses showed that the female gender (odds ratio [OR]/95% confidence interval [CI]/p = 2.001/1.042-3.841/0.037) and MAC scores (OR/95% CI/p = 10.153/4.434-23.253/p < .001) were independent predictors of intraoperative conversion. During a follow-up of 263 ± 134 days, MAC-present patients had more arrhythmias (42.5% vs. 9.5%, p < .001). Also, MAC-scores (hazard ratio [HR]/95% CI/p = 6.841/3.322-14.089/p < .001) and LADD (HR/95% CI/p = 1.039/1.018-1.060/p < .001) were independently associated with arrhythmias by Cox regression analyses.
CONCLUSIONS
Noncontrast cardiac CT-derived MAC-scores showed a high risk for intraoperative conversion and follow-up arrhythmias in MVD-patients.
背景与目的
计算机断层扫描（CT）检测到的二尖瓣环钙化（MAC）被报道为不良结局的独立预测因素。然而，目前尚不清楚定量 MAC 参数是否为二尖瓣疾病（MVD）管理提供更多价值，因此，我们使用非对比心脏 CT 检查评估 MVD 患者 MAC 评分的预后价值。
方法
2020 年 1 月至 2021 年 12 月，前瞻性纳入 300 例接受术前心脏 CT 和二尖瓣（MV）手术的 MVD 患者（MAC 阳性=80 例，MAC 阴性=220 例）。使用非对比心脏 CT 图像定性检测 MAC（阳性或阴性）并评估 MAC 评分。为了分析，我们还收集了基线临床数据、术中转换（从 MV 修复转为 MV 置换）和随访心律失常数据。
结果
与 MAC 阴性组相比，MAC 阳性组患者年龄更大（62±7 岁 vs. 58±9 岁，p<0.001），女性更多（55% vs. 39.5%，p=0.017），且主动脉瓣钙化（57.5% vs. 23.2%，p<0.001）、二尖瓣狭窄（82.5% vs. 61.8%，p<0.001）、心房颤动（30% vs. 11.8%，p<0.001）和左心房舒张末期内径更大（49[44-56] vs. 46[41-50]，p=0.001）。此外，MAC 阳性患者更多地接受 MV 置换术（61.8% vs. 82.5%，p=0.001），术中转换发生率更高（11.8% vs. 61.3%，p<0.001）。多因素逻辑回归分析显示，女性（比值比[OR]/95%置信区间[CI]/p=2.001/1.042-3.841/0.037）和 MAC 评分（OR/95% CI/p=10.153/4.434-23.253/p<0.001）是术中转换的独立预测因素。在 263±134 天的随访期间，MAC 阳性患者心律失常更多（42.5% vs. 9.5%，p<0.001）。此外，MAC 评分（风险比[HR]/95% CI/p=6.841/3.322-14.089/p<0.001）和左心房舒张末期内径（HR/95% CI/p=1.039/1.018-1.060/p<0.001）与 Cox 回归分析中的心律失常独立相关。
结论
非对比心脏 CT 检测到的 MAC 评分显示 MVD 患者术中转换和随访心律失常风险较高。
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