Kojima Motoki, Fujimoto Shinichiro, Noguchi Masahiko, Nozaki Yui Okada, Sato Hideyuki, Kawaguchi Yuko Okano, Tomizawa Nobuo, Doi Shinichiro, Okazaki Shinya, Doryo Kazuhiko, Kogure Yosuke, Tabata Minoru, Minamino Tohru
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan.
Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
Cardiovasc Interv Ther. 2025 Sep 15. doi: 10.1007/s12928-025-01188-5.
Paravalvular leakage (PVL) is one of the complications of transcatheter aortic valve implantation (TAVI), and its occurrence has been reported to affect long-term prognosis. We investigated whether the aortic valve calcification measured on preoperative CT is useful in predicting PVL after TAVI using the fifth-generation self-expanding valves. We analyzed 88 consecutive patients who underwent TAVI with the fifth-generation self-expanding valve from March 2023 to March 2024. Significant PVL was defined as PVL of mild or greater based on postoperative echocardiography results. We performed logistic regression analysis to evaluate whether patient background, and aortic valve calcification volume (AVCa-Vol), maximum CT value (AVCa-Max), mean CT value (AVCa-Ave), Agatston score (AV-Aga) and left ventricular outflow tract (LVOT) calcification volume measured by ECG-gated non-contrast CT were significant predictors. Mild or greater PVL was observed in 26 patients (29.5%). AVCa-Vol (1948.9 mm vs 1427.9 mm, P < 0.01), AV-Aga (2412.8 vs 1743.7, P < 0.01), and LVOT calcification volume (109.8 vs 28.6, P < 0.01) were significantly higher in the PVL group. Univariate logistic regression analysis identified AVCa-Vol and AV-Aga as significant predictors, and they remained independent predictors after adjustment for age and sex (AVCa-Vol: odds ratio (OR) 2.91 (95% Confidence Interval (CI) 1.36-6.20), P < 0.01, AV-Aga: OR 2.24 (95% CI 1.25-4.03), P < 0.01). Receiver operating characteristic analysis showed optimal cutoff values for AVCa-Vol at 1665.13 mm (Area under the curve (AUC) = 0.73) and AV-Aga at 1908.59 (AUC = 0.72). AVCa-Vol and AV-Aga were identified as significant predictors of PVL occurrence after TAVI using the fifth-generation self-expandable valve.
瓣周漏（PVL）是经导管主动脉瓣植入术（TAVI）的并发症之一，据报道其发生会影响长期预后。我们研究了术前CT测量的主动脉瓣钙化是否有助于预测使用第五代自膨胀瓣膜进行TAVI术后的PVL。我们分析了2023年3月至2024年3月连续接受第五代自膨胀瓣膜TAVI的88例患者。根据术后超声心动图结果，显著PVL定义为轻度或更严重的PVL。我们进行了逻辑回归分析，以评估患者背景、主动脉瓣钙化体积（AVCa-Vol）、最大CT值（AVCa-Max）、平均CT值（AVCa-Ave）、阿加斯顿评分（AV-Aga）以及通过心电图门控非增强CT测量的左心室流出道（LVOT）钙化体积是否为显著预测因素。26例患者（29.5%）观察到轻度或更严重的PVL。PVL组的AVCa-Vol（1948.9mm对1427.9mm，P<0.01）、AV-Aga（2412.8对1743.7，P<0.01）和LVOT钙化体积（109.8对28.6，P<0.01）显著更高。单因素逻辑回归分析确定AVCa-Vol和AV-Aga为显著预测因素，在调整年龄和性别后，它们仍然是独立预测因素（AVCa-Vol：比值比（OR）2.91（95%置信区间（CI）1.36-6.20），P<0.01，AV-Aga：OR 2.24（95%CI 1.25-4.03），P<0.01）。受试者工作特征分析显示，AVCa-Vol的最佳截断值为1665.13mm（曲线下面积（AUC）=0.73），AV-Aga的最佳截断值为1908.59（AUC=0.72）。AVCa-Vol和AV-Aga被确定为使用第五代自膨胀瓣膜进行TAVI术后PVL发生的显著预测因素。
