MDCT 测量主动脉瓣钙化密度评估主动脉瓣狭窄严重程度。

Aortic Valve Calcification Density Measured by MDCT in the Assessment of Aortic Stenosis Severity.

机构信息

Institut Universitaire de Cardiologie et Pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, Canada (A.P., N.L., N.S.B.M., L.T., C.R., M.-A.C.).

Faculty of Medicine, University of Southern Denmark, Odense (M.A., A.H., N.S.B.M., K.A.Ø., J.S.D., M.-A.C.).

出版信息

Circ Cardiovasc Imaging. 2024 May;17(5):e016267. doi: 10.1161/CIRCIMAGING.123.016267. Epub 2024 May 21.

DOI:10.1161/CIRCIMAGING.123.016267

PMID:38771899

Abstract

BACKGROUND

Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCd) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCd) has never been evaluated. The aim of this study was to compare AVC, AVCd, and AVCd with regard to hemodynamic correlations and clinical outcomes in patients with AS.

METHODS

Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCd severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.

RESULTS

Correlations between gradient/velocity and AVCd were stronger (both ≤0.005) using AVCd (r=0.68, <0.001 and r=0.66, <0.001) than AVC (r=0.61, <0.001 and r=0.60, <0.001) or AVCd (r=0.61, <0.001 and r=0.59, <0.001). AVCd thresholds for the identification of severe AS were 334 Agatston units (AU)/cm for women and 467 AU/cm for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCd ratio was superior to AVC ratio and AVCd ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; <0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; =0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; <0.001; all likelihood test ≤0.004). AVCd ratio was superior to AVC ratio and AVCd ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; <0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; =0.007; HR, 1.28 [95% CI, 1.03-1.57]; =0.01; all likelihood test <0.03). AVCd ratio predicts mortality in all subgroups of patients with AS.

CONCLUSIONS

AVCd appears to be equivalent or superior to AVC and AVCd to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCd thresholds of 300 AU/cm for women and 500 AU/cm for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.

摘要

背景

通过多普勒超声心动图（AVCd）测量的主动脉瓣钙化（AVC）指数与主动脉瓣环（AA）面积相关，为主动脉瓣狭窄（AS）患者提供了强大的预后信息。然而，通过多排 CT（AVCd）测量的 AA 指数尚未得到评估。本研究的目的是比较 AVC、AVCd 和 AVCd 在 AS 患者的血流动力学相关性和临床结局方面的差异。

方法

回顾性分析了 889 名主要为白人的钙化性 AS 患者的数据，这些患者在同一治疗期间接受了多普勒超声心动图和多排 CT 检查。AA 同时通过多普勒超声心动图和多排 CT 进行测量。使用接收者操作特征曲线分析分别在男性和女性中建立 AVCd 严重程度的截断值。主要终点是全因死亡率的发生。

结果

使用 AVCd（r=0.68，<0.001 和 r=0.66，<0.001）比 AVC（r=0.61，<0.001 和 r=0.60，<0.001）或 AVCd（r=0.61，<0.001 和 r=0.59，<0.001）测量时，梯度/速度与 AVCd 的相关性更强（均≤0.005）。女性严重 AS 的 AVCd 截断值为 334 个 Agatston 单位（AU）/cm，男性为 467 AU/cm。在中位数为 6.62（6.19-9.69）年的随访中，在多变量分析中，AVCd 比值优于 AVC 比值和 AVCd 比值预测全因死亡率（危险比[HR]，1.59[95%CI，1.26-2.00]；<0.001 与 HR，1.53[95%CI，1.11-1.65]；=0.003 与 HR，1.27[95%CI，1.11-1.46]；<0.001；所有似然检验≤0.004）。在多变量分析中，AVCd 比值优于 AVC 比值和 AVCd 比值预测药物治疗下的生存率（HR，1.80[95%CI，1.27-1.58]；<0.001 与 HR，1.55[95%CI，1.13-2.10]；=0.007 与 HR，1.28[95%CI，1.03-1.57]；=0.01；所有似然检验<0.03）。AVCd 比值可预测所有亚组患者的死亡率。

结论

AVCd 似乎与 AVC 和 AVCd 相当或优于它们，可用于评估 AS 严重程度并预测全因死亡率。因此，在超声心动图检查结果不确定或伴有低血流状态的患者中，应使用 AVCd 来评估 AS 严重程度。女性 AVCd 截断值为 300 AU/cm，男性为 500 AU/cm 似乎适合识别严重 AS。需要进一步的研究来验证这些截断值，特别是在不同人群中。