Kletzer Joseph, Scharinger Bernhard, Demirel Ozan, Kaufmann Reinhard, Medved Michaela, Reiter Christian, Hammerer Matthias, Steinwender Clemens, Hecht Stefan, Kopp Kristen, Hoppe Uta C, Hergan Klaus, Boxhammer Elke
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
J Clin Med. 2024 Mar 29;13(7):1999. doi: 10.3390/jcm13071999.
Echocardiography has long been established as the primary noninvasive method for diagnosing pulmonary hypertension (PH) prior to transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis (AS). In recent years, radiological methods for diagnosing PH have been investigated. Measurements such as the computed tomography angiography (CTA)-derived pulmonary artery (PA) diameter and PA diameter/body surface area (PA/BSA) have shown promising results regarding their diagnostic strength. However, it has yet to be determined if a patient's sex has any impact on the effectiveness of these diagnostic measurements. In all, 271 patients (51.3% male, mean age 82.6 ± 4.8 years) with severe AS undergoing TAVR were separated into male and female groups. The cut-off values for the diagnosis of PH were calculated for the CTA-derived PA diameter and PA/BSA based on different systolic pulmonal artery pressure values (40-45-50 mmHg). Patients were then subclassified according to measurements above or below these PA diameters and PA/BSA cut-off values. A PA diameter ≥29.5 mm and PA/BSA ≥ 15.7 mm/m qualified for PH. The 1-5 year survival rate in these cohorts was further analyzed. Patients with a PA diameter ≥29.5 mm showed a significantly higher 1 year mortality rate ( = 0.014). This observation could only be confirmed for the male sex ( = 0.018) and not for the female sex ( = 0.492). As for the PA/BSA, in patients over the cut-off value, no significant increase in mortality was noted in the overall cohort. However, the male patients showed increased 3 year ( = 0.048) and 5 year mortality rates ( = 0.033). The CTA-obtained PA diameter and PA/BSA are both useful in the diagnosis of PH and mortality risk stratification in patients with severe AS undergoing TAVR, especially in males. Male patients with PA ≥ 29.5 mm or PA/BSA ≥ 15.7 mm/m seem to be at a higher risk of death during follow-up after undergoing TAVR. In females, no such correlation was observed.
长期以来，超声心动图一直是严重主动脉瓣狭窄（AS）患者经导管主动脉瓣置换术（TAVR）前诊断肺动脉高压（PH）的主要非侵入性方法。近年来，已对诊断PH的放射学方法进行了研究。诸如计算机断层扫描血管造影（CTA）得出的肺动脉（PA）直径和PA直径/体表面积（PA/BSA）等测量指标在诊断强度方面显示出了有前景的结果。然而，患者性别对这些诊断测量的有效性是否有任何影响尚未确定。总共271例接受TAVR的严重AS患者（51.3%为男性，平均年龄82.6±4.8岁）被分为男性和女性组。根据不同的收缩期肺动脉压值（40 - 45 - 50 mmHg），计算出CTA得出的PA直径和PA/BSA用于诊断PH的临界值。然后根据这些PA直径和PA/BSA临界值以上或以下的测量结果对患者进行亚分类。PA直径≥29.5 mm且PA/BSA≥15.7 mm/m²符合PH诊断标准。对这些队列中的1至5年生存率进行了进一步分析。PA直径≥29.5 mm的患者1年死亡率显著更高（P = 0.014）。这一观察结果仅在男性中得到证实（P = 0.018），在女性中未得到证实（P = 0.492）。至于PA/BSA，在超过临界值的患者中，总体队列中死亡率没有显著增加。然而，男性患者3年（P = 0.048）和5年死亡率有所增加（P = 0.033）。CTA获得的PA直径和PA/BSA在接受TAVR的严重AS患者的PH诊断和死亡风险分层中均有用，尤其是在男性中。PA≥29.5 mm或PA/BSA≥15.7 mm/m²的男性患者在接受TAVR后的随访期间似乎死亡风险更高。在女性中，未观察到这种相关性。
