重度主动脉瓣狭窄行经导管主动脉瓣置换术患者主肺动脉与升主动脉直径比值的预后影响。
Prognostic impact of main pulmonary artery to ascending aorta diameter ratio in patients with severe aortic stenosis underwent transcatheter aortic valve implantation.
机构信息
Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey.
Depatment of Internal Medicine, Ascension St. Vincent Hospital, Indianapolis, Indiana, USA.
出版信息
Catheter Cardiovasc Interv. 2024 Apr;103(5):782-791. doi: 10.1002/ccd.31000. Epub 2024 Feb 28.
BACKGROUND
Pulmonary hypertension (PH) and right ventricular dysfunction are poor prognostic predictors in patients underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS).
AIMS
The prognostic impact of the main pulmonary artery/ascending aorta diameter ratio (MPA/AOr), measured simply by computed-tomographic angiography (CTA), was investigated in this patient group.
METHODS
A total of 374 retrospectively evaluated patients (mean age 78.1 ± 8.4 years, 192 [51.3%] females) who underwent TAVI for severe AS were included. MPA/AOr was measured on preprocedural CTA in all patients and the effect of this measurement on the presence of PH, in-hospital and 2-year-overall long-term mortality was investigated.
RESULTS
The presence of PH was defined as a systolic pulmonary artery pressure (sPAP) >42 mmHg measured by echocardiography. According to multivariate-logistic-regression analysis, MPA/AOr (adjusted [Adj] odds ratio [OR]: 1.188, confidence interval [CI] 95% [1.002-1.410], p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (adj OR:0.736, CI 95% [0.663-0.816], p < 0.001) and left atrial diameter (adj OR:1.051, CI 95% [1.007-1.098], p = 0.024) were identified as independent predictors of PH. In addition, a statistically significant correlation was found between MPA/AOr and TAPSE (r: -0.283, p < 0.001). Furthermore, MPA/AOr was found to be an independent predictor of both in-hospital (adj OR:1.434, CI 95% [1.093-1.881], p = 0.009) and 2-year long-term (adj OR:1.518, CI 95% [1.243-1.853], p < 0.001) mortality in multivariate analysis including TAPSE, STS score and sPAP. In the 2-year Kaplan-Meier survival probability analysis, an MPA/AOr >0.86 was found to have a hazard ratio of 3.697 (95% CI: 2.341-5.840), with a log-rank p < 0.001.
CONCLUSION
MPA/AOr, which can be measured simply by CTA, may be useful as an indicator of the presence of PH and poor prognosis in patients planned for TAVI for severe AS.
背景
在接受经导管主动脉瓣置换术（TAVI）治疗严重主动脉瓣狭窄（AS）的患者中，肺动脉高压（PH）和右心室功能障碍是预后不良的预测因素。
目的
本研究旨在探讨通过计算机断层扫描血管造影（CTA）简单测量的主肺动脉/升主动脉直径比（MPA/AOr）在该患者群体中的预后影响。
方法
回顾性分析了 374 例接受 TAVI 治疗严重 AS 的患者（平均年龄 78.1±8.4 岁，192 例[51.3%]为女性）。所有患者均在术前 CTA 上测量 MPA/AOr，并探讨该测量值对 PH、院内和 2 年总体长期死亡率的影响。
结果
PH 的定义为超声心动图测量的收缩期肺动脉压（sPAP）>42mmHg。多变量逻辑回归分析显示，MPA/AOr（调整后比值比[OR]：1.188，95%置信区间[CI]：1.002-1.410，p=0.048）、三尖瓣环平面收缩期位移（TAPSE）（调整后 OR：0.736，95%CI：0.663-0.816，p<0.001）和左心房直径（调整后 OR：1.051，95%CI：1.007-1.098，p=0.024）是 PH 的独立预测因素。此外，MPA/AOr 与 TAPSE 之间存在统计学显著相关性（r：-0.283，p<0.001）。此外，MPA/AOr 是院内（调整后 OR：1.434，95%CI：1.093-1.881，p=0.009）和 2 年长期（调整后 OR：1.518，95%CI：1.243-1.853，p<0.001）死亡率的独立预测因素，多变量分析包括 TAPSE、STS 评分和 sPAP。在 2 年 Kaplan-Meier 生存概率分析中，MPA/AOr>0.86 的患者的风险比为 3.697（95%CI：2.341-5.840），对数秩检验 p<0.001。
结论
MPA/AOr 可通过 CTA 简单测量，可能可作为预测 TAVI 治疗严重 AS 患者 PH 存在和预后不良的指标。
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