Amsalem Itshak, Vitkon-Barkay Itzhak, Rav-Acha Moshe, Dvir Danny, Elkan Matan, Pichkhadze Olga, Bogot Naama, Shaheen Fauzi, Hitter Rafael, Chutko Boris, Glikson Michael, Leipsic Jonathon, Wolak Arik
Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel.
Cardiology Division, Shamir Medical Center, Zerifin 7033001, Israel.
J Clin Med. 2025 Jan 28;14(3):878. doi: 10.3390/jcm14030878.
CT-TAVI is a critical component of pre-TAVI assessment. The conventional method, retrospective ECG-gated scan, covering a complete cardiac cycle, measures the annulus during optimal systolic phases. Recently, prospective ECG-triggered scans acquiring images at a specific interval of the cardiac cycle were evaluated, allowing faster acquisition and lower contrast doses. Moreover, these scans might be beneficial for elderly patients, reducing the need for breath-holding and easing cooperation requirements. Still, their impact on annular measurement and procedural success has yet to be fully evaluated. This retrospective, single-center study included 419 patients who underwent CT-TAVI scans, by either prospective or retrospective scanning methods. Baseline data and calculated surgical risk scores were collected, with propensity score matching performed, followed by univariate analysis, Cox regression, and multivariable regression analysis. A total of 171 patient pairs were generated via propensity score matching, ensuring that both groups had similar distributions of age (81 ± 8 years), sex (55% males), and baseline comorbidities. The patients in the prospective ECG-triggered group were exposed to a smaller amount of contrast material (40.0 ± 12 mL vs. 70.0 ± 48 mL, < 0.001) and radiation (4.4 ± 3.6 mSv vs. 8.0 ± 10.3 mSv, < 0.001). The prospective ECG-triggered group had a smaller aortic annulus area and diameter (426.6 ± 121.0 mm vs. 469.1 ± 130.8 mm, = 0.006 and 23.3 ± 3.2 mm vs. 24.5 ± 3.6 mm, = 0.004) but no excess paravalvular leak was observed. Multivariable analysis showed no significant differences in mortality and composite endpoints between the two groups after 23 months of follow-up. Prospective ECG-triggered, ultra-fast, low-dose, high-pitch scan protocol, used in selected patients offers comparable safety and clinical procedural outcomes along with time and contrast savings.
CT引导下经导管主动脉瓣植入术（CT-TAVI）是TAVI术前评估的关键组成部分。传统方法是回顾性心电图门控扫描，涵盖完整心动周期，在最佳收缩期测量瓣环。最近，对在心动周期特定间期采集图像的前瞻性心电图触发扫描进行了评估，其可实现更快采集并降低造影剂剂量。此外，这些扫描可能对老年患者有益，减少屏气需求并降低合作要求。不过，其对瓣环测量和手术成功率的影响尚未得到充分评估。这项回顾性单中心研究纳入了419例行CT-TAVI扫描的患者，采用前瞻性或回顾性扫描方法。收集基线数据和计算手术风险评分，进行倾向评分匹配，随后进行单因素分析、Cox回归和多变量回归分析。通过倾向评分匹配共生成171对患者，确保两组在年龄（81±8岁）、性别（55%为男性）和基线合并症方面分布相似。前瞻性心电图触发组患者接受的造影剂剂量较少（40.0±12 mL对70.0±48 mL，<0.001）和辐射剂量较低（4.4±3.6 mSv对8.0±10.3 mSv，<0.001）。前瞻性心电图触发组的主动脉瓣环面积和直径较小（426.6±121.0 mm对469.1±130.8 mm，P=0.006；23.3±3.2 mm对24.5±3.6 mm，P=0.004），但未观察到瓣周漏增加。多变量分析显示，随访23个月后两组在死亡率和复合终点方面无显著差异。在选定患者中使用的前瞻性心电图触发、超快速、低剂量、高螺距扫描方案，在节省时间和造影剂的同时，提供了相当的安全性和临床手术结果。
