Hoang Timothy, Baran Timothy M, Marinescu Mark, Mandalapu Aniruddh, Chaturvedi Abhishek
Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States.
Department of Cardiology, University of Rochester Medical Center, Rochester, New York, United States.
J Clin Imaging Sci. 2025 Apr 30;15:14. doi: 10.25259/JCIS_130_2024. eCollection 2025.
The objectives of the study are to identify usefulness of chest radiography (CXR) and computed tomography (CT) for the assessment of optimal Impella positioning compared to echocardiography.
In this retrospective study, records of 500 patients were reviewed, 95 subjects met the inclusion criteria. The distance from the carina, top of the aortic arch, and in case of CT, from the aortic valve plane to the Impella inlet port was measured. Subjects were stratified into two groups based on echocardiography: Those that did require repositioning and those that did not.
CT revealed greater distance from the carina to the aortic valve plane in patients requiring Impella repositioning compared to those which did not (81.6 ± 15.9 mm vs. 67 ± 13.2 mm, = 0.019). The distance from the aortic valve plane to the Impella inlet was shorter in repositioned cases on CT (22.3 ± 28.6 mm vs. 35.8 ± 13.3 mm, = 0.045). The expected location of the aortic valve plane was 6.8 ± 1.3 cm from the carina among CT cases, representing a useful measurement for evaluation on CXR. Significant predictors of aortic valve plane to carina distance on CT were found to be aortic arch to Impella outlet on CXR ( < 0.0001) and carina to Impella outlet on CXR ( < 0.0001).
CT imaging correctly identified patients that required repositioning on echocardiography. Key CT measurements serve as crucial indicators for repositioning and there is notable agreement on measurements across CXR and CT as well as CT and echocardiography in identification of Impella high or low positioning. In addition, there is evidence of significant predictors of CT measurements from CXR.
本研究的目的是确定与超声心动图相比，胸部X线摄影（CXR）和计算机断层扫描（CT）在评估Impella最佳定位方面的有用性。
在这项回顾性研究中，对500例患者的记录进行了审查，95名受试者符合纳入标准。测量了从隆突、主动脉弓顶部的距离，对于CT检查，还测量了从主动脉瓣平面到Impella入口端口的距离。根据超声心动图将受试者分为两组：需要重新定位的和不需要重新定位的。
与不需要重新定位的患者相比，CT显示需要重新定位Impella的患者从隆突到主动脉瓣平面的距离更大（81.6±15.9mm对67±13.2mm，P = 0.019）。在CT上，重新定位的病例中从主动脉瓣平面到Impella入口的距离较短（22.3±28.6mm对35.8±13.3mm，P = 0.045）。在CT病例中，主动脉瓣平面距隆突的预期位置为6.8±1.3cm，这是CXR评估的一个有用测量值。发现CT上主动脉瓣平面到隆突距离的显著预测因素是CXR上主动脉弓到Impella出口的距离（P<0.0001）和CXR上隆突到Impella出口的距离（P<0.0001）。
CT成像正确识别了超声心动图检查需要重新定位的患者。关键的CT测量值是重新定位的关键指标，在识别Impella高或低定位方面，CXR和CT以及CT和超声心动图之间的测量结果有显著一致性。此外，有证据表明CXR是CT测量值的重要预测因素。
