经导管主动脉瓣植入术患者中心脏损伤与计算机断层扫描衍生细胞外容积的关联

Association of Cardiac Damage and Computed Tomography-Derived Extracellular Volume in Patients Undergoing Transcatheter Aortic Valve Implantation.

作者信息

Belmonte Marta, Paolisso Pasquale, de Oliveira Elayne Kelen, Bladt Olivier, Terzi Riccardo, Mistrulli Raffaella, Corradetti Sara, Viscusi Michele, Marchetti Davide, Ratti Angelo, Schillaci Matteo, Gallinoro Emanuele, Wyffels Eric, Penicka Martin, Conte Edoardo, Barbato Emanuele, Andreini Daniele, Vanderheyden Marc

机构信息

Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy; Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy.

Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy.

出版信息

Can J Cardiol. 2025 Feb 27. doi: 10.1016/j.cjca.2025.02.031.

DOI:10.1016/j.cjca.2025.02.031

PMID:40023285

Abstract

BACKGROUND

Extravalvular cardiac damage (EVCD) and extracellular volume (ECV) are key determinants of poor outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We aimed to assess the association of ECV derived by means of cardiac computed tomography (CT) with EVCD before and after TAVI, its impact on left ventricular reverse remodelling, and functional improvements at 3-month follow-up in patients with severe AS undergoing TAVI.

METHODS

This was a prospective study of 73 consecutive patients undergoing TAVI, with CT-derived ECV assessment and baseline and follow-up echocardiographic evaluation of EVCD. After identifying the best ECV cutoff for predicting EVCD progression and advanced EVCD (stages 3-4) at follow-up according to the Youden index, patients were divided into low (n = 39) and high (n = 34) ECV groups. Predictors of EVCD progression, advanced EVCD, and functional improvements at follow-up were identified by means of logistic regression analysis.

RESULTS

At 3-month follow-up, 34.2% of patients showed EVCD progression. ECV ≥ 32% accurately predicted EVCD progression and stages 3-4 (area under the receiver operating characteristic curve 0.66, P < 0.001). At follow-up, patients with high ECV were more frequently in stages 3-4 (P = 0.011) and had a 50% progression rate (P = 0.012). Conversely, patients with low ECV exhibited greater LV reverse remodelling (P = 0.004) and improvement in New York Heart Association (NYHA) functional class at both 3-month (P = 0.020) and 6-month (P = 0.001) follow-ups compared with patients with high ECV. High ECV emerged as an independent predictor of EVCD progression (odds ratio [OR] 4.34, 95% CI 1.36-13.78, P = 0.013), stages 3-4 (OR 5.71, 95% CI 1.77-18.42, P = 0.004) and lack of improvement in NYHA functional class (OR 3.22, 95% CI 1.14-9.09, P = 0.027) at 3-month follow-up.

CONCLUSIONS

Elevated CT-derived ECV was associated with EVCD progression and reduced functional improvement after TAVI.

摘要

背景

瓣外心脏损害（EVCD）和细胞外容积（ECV）是接受经导管主动脉瓣植入术（TAVI）的严重主动脉瓣狭窄（AS）患者预后不良的关键决定因素。我们旨在评估通过心脏计算机断层扫描（CT）得出的ECV与TAVI前后EVCD的关联、其对左心室逆向重构的影响以及TAVI术后3个月随访时的功能改善情况。

方法

这是一项对73例连续接受TAVI的患者进行的前瞻性研究，对其进行CT衍生的ECV评估以及EVCD的基线和随访超声心动图评估。根据约登指数确定预测随访时EVCD进展和晚期EVCD（3 - 4期）的最佳ECV临界值后，将患者分为低ECV组（n = 39）和高ECV组（n = 34）。通过逻辑回归分析确定EVCD进展、晚期EVCD和随访时功能改善的预测因素。

结果

在3个月随访时，34.2%的患者出现EVCD进展。ECV≥32%准确预测了EVCD进展和3 - 4期（受试者工作特征曲线下面积为0.66，P < 0.001）。随访时，高ECV患者更频繁处于3 - 4期（P = 0.011），且进展率为50%（P = 0.012）。相反，与高ECV患者相比，低ECV患者在3个月（P = 0.020）和6个月（P = 0.001）随访时均表现出更大程度的左心室逆向重构以及纽约心脏协会（NYHA）功能分级的改善。高ECV是EVCD进展（比值比[OR] 4.34，95%可信区间1.36 - 13.78，P = 0.013）、3 - 4期（OR 5.71，95%可信区间1.77 - 18.42，P = 0.004）和3个月随访时NYHA功能分级无改善（OR 3.22，95%可信区间1.14 - 9.09，P = 0.027）的独立预测因素。