美国不同人群中CT血管造影对主动脉瓣狭窄的特征分析
Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort.
作者信息
Lorenzatti Daniel, Filtz Annalisa, Pina Pamela, Geers Jolien, Gilman Jake, Daich Jonathan, Ippolito Paul, Aftab Abdullah, Schenone Aldo L, Gongora Carlos A, Johannesen Justin, Scotti Andrea, Ho Edwin C, Garcia Mario J, Latib Azeem, Rodriguez Carlos J, Berman Daniel S, Clavel Marie-Annick, Pibarot Philippe, Bonow Robert O, Slomka Piotr J, Dweck Marc R, Dey Damini, Slipczuk Leandro
机构信息
Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY (D.L., A.F., J. Gilman, J.D., P.I., A.A., A.L.S., C.A.G., J.J., A.S., E.C.H., M.J.G., A.L., C.J.R., L.S.).
Department of Cardiology, Centro de Diagnóstico, Medicina Avanzada y Telemedicina (CEDIMAT), Santo Domingo, Dominican Republic (P. Pina).
出版信息
Circ Cardiovasc Imaging. 2025 Jun;18(6):e017858. doi: 10.1161/CIRCIMAGING.124.017858. Epub 2025 May 9.
BACKGROUND
Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning.
METHODS
We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype.
RESULTS
The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm³/cm²; <0.001) and calcific volumes (85 versus 149 mm³/cm²; <0.001), and higher fibro-calcific ratio (1.47 versus 0.83; <0.001). No differences were observed in the fibrotic volumes (=0.805). NH-White women had higher fibro-calcific (256 mm³/cm², =0.002) and fibrotic volumes (145 mm³/cm²; <0.001), and fibro-calcific ratio (1.57; =0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm/cm; <0.001) and calcific volumes (148 versus 88 mm/cm; <0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; <0.001), although no difference in fibrotic volume (=0.099) compared with low-gradient AS.
CONCLUSIONS
Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.
背景
主动脉瓣狭窄（AS）涉及瓣膜组织的钙化和纤维化退变。评估这两种过程的唯一非侵入性方法是对比增强计算机断层扫描血管造影。我们旨在探讨在美国因经导管主动脉瓣置换术规划而转诊的患者中，主动脉瓣（AV）组织组成在性别、种族/族裔和AS血流动力学表型方面的差异。
方法
我们回顾性分析了2015年至2022年间因经导管主动脉瓣置换术规划而接受计算机断层扫描血管造影的有症状AS患者。使用半自动软件，我们通过纤维化、钙化和纤维钙化体积以及纤维钙化比率（纤维化/钙化体积）来量化AV组织组成，作为瓣膜表型的一种度量。
结果
该研究纳入了651例患者（平均年龄84岁；55%为女性），其中38%为非西班牙裔（NH）白人，27%为西班牙裔，13%为NH黑人。女性的纤维钙化体积（230对293mm³/cm²；<0.001）和钙化体积（85对149mm³/cm²；<0.001）较低，纤维钙化比率较高（1.47对0.83；<0.001）。纤维化体积无差异（P=0.805）。与西班牙裔和NH黑人女性相比，NH白人女性的纤维钙化体积（256mm³/cm²，P=0.002）和纤维化体积（145mm³/cm²；<0.001）以及纤维钙化比率（1.57；P=0.01）更高。男性之间未发现差异。高梯度AS的纤维钙化体积（295对219mm/cm；<0.001）和钙化体积（148对88mm/cm；<0.001）更高，纤维钙化比率更低（0.90对1.45；<0.001），尽管与低梯度AS相比，纤维化体积无差异（P=0.099）。
结论
在因经导管主动脉瓣置换术转诊的AS患者中，计算机断层扫描血管造影瓣膜组织组成存在表型差异，女性和低梯度AS表现出比例上更多的纤维化表型。NH白人女性的纤维化组织组成最高，男性之间无明显差异。
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