通过早期和晚期计算机断层扫描上左心耳充盈缺损模式预测重度主动脉瓣狭窄患者的中风
Prediction of stroke in patients with severe aortic stenosis by left atrial appendage filling defect patterns on early and late-phase computed tomography.
作者信息
Lacaita Pietro G, Bleckwenn Sven, Barbieri Fabian, Scharll Yannick, Deeg Johannes, Bonaros Nikolaos, Widmann Gerlig, Feuchtner Gudrun M
机构信息
Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany.
出版信息
Int J Cardiol Heart Vasc. 2024 Dec 9;56:101576. doi: 10.1016/j.ijcha.2024.101576. eCollection 2025 Feb.
BACKGROUND
Stroke is a feared complication after TAVI. The objective was to assess whether left atrial appendage (LAA) filling-defect (FD) patterns from early and late-phase computed tomography (CT), predict stroke/TIA in patients with severe aortic stenosis.
METHODS
124 patients with severe aortic stenosis (79.5y, 46.8% females) who underwent CT-Angiography for TAVI-planning were included (66.1% underwent TAVI, 18.6% surgical, 15.3% conservative treatment).CT-image-analysis included: CT-density (HU) from LAA tip-to-base and HU-gradients (I-III), the HU-ratio LAA/aorta, left-atrial-wall-thickness (LAWT) and the periatrial fat attenuation index (FAI).
RESULTS
Stroke/TIA rate was 9.6 %. LAA-HU-gradient was slightly higher in non-stroke patients (p = 0.087). Persisting FDs during the late-phase were associated with stroke (p = 0.047) but not early-phase FDs. Early-phase FDs with HU < 245 (n = 15) were correlated with stroke (p = 0.05). A LAA-HU-gradient > 10HU had 91 % sensitivity and 68 % specificity for prediction of stroke. LAA-HU gradient I had a moderate accuracy ( 95 %CI:0.472-0.711; p = 0.317) for discrimination of stroke during the early phase, which enhanced during the late phase (;95 %CI:0.503-0.868; p = 0.046). Patients with stroke had a higher rate of FDs with HU-progression from early to late phase (>10HU)(p = 0.013), while the ratios LAA/aorta, LAWT, and periatrial-FAI were not different. Among clinical parameters, only age predicted stroke but not CHA2DS2-VASc-score. In multivariate analysis, late-phase FDs (p = 0.059)(OR 5.66: 95 %CI:0.936-34.28) but not early-phase FD were associated with stroke, and none of the major conventional risk factors.
CONCLUSION
Persisting LAA-filling defects on CT during the late-phase, and early-phase FD with <245HU predict stroke, and a CT-density progression >10HU from early-to-late phase. LAA-FD may improve stroke risk stratification.
背景
中风是经导管主动脉瓣置入术（TAVI）后令人担忧的并发症。目的是评估早期和晚期计算机断层扫描（CT）显示的左心耳（LAA）充盈缺损（FD）模式是否能预测严重主动脉瓣狭窄患者的中风/短暂性脑缺血发作（TIA）。
方法
纳入124例因TAVI计划而行CT血管造影的严重主动脉瓣狭窄患者（年龄79.5岁，46.8%为女性）（66.1%接受了TAVI，18.6%接受了外科手术，15.3%接受了保守治疗）。CT图像分析包括：从LAA尖端到基部的CT密度（HU）和HU梯度（I-III）、LAA/主动脉的HU比值、左心房壁厚度（LAWT）和心房周围脂肪衰减指数（FAI）。
结果
中风/TIA发生率为9.6%。非中风患者的LAA-HU梯度略高（p = 0.087）。晚期持续存在的FD与中风相关（p = 0.047），但早期FD与中风无关。HU < 245的早期FD（n = 15）与中风相关（p = 0.05）。LAA-HU梯度> 10HU对中风预测的敏感性为91%，特异性为68%。LAA-HU梯度I在早期对中风的鉴别具有中等准确性（95%CI：0.472 - 0.711；p = 0.317），在晚期准确性增强（95%CI：0.503 - 0.868；p = 0.046）。中风患者中，从早期到晚期HU进展> 10HU的FD发生率更高（p =
0.013），而LAA/主动脉比值、LAWT和心房周围FAI无差异。在临床参数中，只有年龄可预测中风，而CHA2DS2-VASc评分不能预测。多变量分析显示，晚期FD（p = 0.059）（OR 5.66：95%CI：0.936 - 34.28）而非早期FD与中风相关，且与主要传统危险因素无关。
结论
CT上晚期持续存在的LAA充盈缺损、HU < 245的早期FD以及从早期到晚期CT密度进展> 10HU可预测中风，LAA-FD可能改善中风风险分层。
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