Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients.
Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients.
复制标题
主动脉瓣钙化评分与经导管主动脉瓣置换术患者急性卒中相关。
DOI：
10.1016/j.jscai.2022.100349
复制
发表时间：
2022-07
期刊：
影响因子：
--
通讯作者：
Sen, Sayan
中科院分区：
文献类型：
--
作者：
Foley, Michael;Hall, Kerry;Howard, James P;Ahmad, Yousif;Gandhi, Manisha;Mahboobani, Samir;Okafor, Joseph;Rahman, Haseeb;Hadjiloizou, Nearchos;Ruparelia, Neil;Mikhail, Ghada;Malik, Iqbal;Kanaganayagam, Gajen;Sutaria, Nilesh;Rana, Bushra;Ariff, Ben;Barden, Edward;Anderson, Jonathan;Afoke, Jonathan;Petraco, Ricardo;Al-Lamee, Rasha;Sen, Sayan
经导管主动脉瓣置换术（TAVR）是中度或较高手术风险的重度主动脉瓣狭窄患者的首选治疗方法。卒中是TAVR公认的严重并发症，识别卒中风险较高的患者非常重要。本研究旨在发现TAVR前计算机断层扫描计算的主动脉瓣钙评分是否与TAVR患者的急性卒中相关。我们对2017年1月至2019年12月期间在Hammersmith医院接受TAVR的433例连续患者进行了一项回顾性、观察性队列研究。该队列的中位年龄为83岁（四分位距，78-87），52.7%为男性。52例患者（12.0%）有既往卒中或短暂性脑缺血发作史。中位主动脉瓣钙评分为2145（四分位距，1427-3247）Agatston单位。22例患者在出院时发生卒中（5.1%）。在逻辑回归模型中，主动脉瓣钙化评分与急性卒中显著相关（比值比[OR]，1.26; 95%置信区间[CI]，1.01-1.53; P = 0.02）。急性卒中还与外周动脉疾病（OR，4.32; 95% CI，1.65-10.65; P = 0.0018）和手术时间较长（OR，1.01; 95% CI，1.00-1.02; P = 0.0006）显著相关。TAVR前计算机断层扫描的主动脉瓣钙评分是TAVR人群中急性卒中的独立风险因素。这是TAVR前主动脉瓣钙评分的额外临床价值，在讨论围手术期卒中风险时应予以考虑。卒中是经导管主动脉瓣置换术的重要并发症。计算机断层扫描可以在介入前量化主动脉瓣钙化。CT显示主动脉瓣钙化与TAVR术后卒中相关。这可以为TAVR之前个体患者中风风险的讨论提供信息。
Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis who are at a moderate or higher surgical risk. Stroke is a recognised and serious complication of TAVR, and it is important to identify patients at higher stroke risk. This study aims to discover if aortic valve calcium score calculated from pre-TAVR computed tomography is associated with acute stroke in TAVR patients. We conducted a retrospective, observational cohort study of 433 consecutive patients undergoing TAVR between January 2017 and December 2019 at the Hammersmith Hospital. This cohort had a median age of 83 years (interquartile range, 78-87), and 52.7% were male. Fifty-two patients (12.0%) had a history of previous stroke or transient ischemic attack. Median aortic valve calcium score was 2145 (interquartile range, 1427-3247) Agatston units. Twenty-two patients had a stroke up to the time of discharge (5.1%). In a logistic regression model, aortic valve calcium score was significantly associated with acute stroke (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.01-1.53; P = .02). Acute stroke was also significantly associated with peripheral arterial disease (OR, 4.32; 95% CI, 1.65-10.65; P = .0018) and a longer procedure time (OR, 1.01; 95% CI, 1.00-1.02; P = .0006). Aortic valve calcium score from pre-TAVR computed tomography is an independent risk factor for acute stroke in the TAVR population. This is an additional clinical value of the pre-TAVR aortic valve calcium score and should be considered when discussing periprocedural stroke risk. Stroke is a significant complication of transcatheter aortic valve replacement. Computed tomography can quantify aortic valve calcification prior to intervention. Aortic valve calcium on CT was associated with post-TAVR stroke. This could inform discussions of individual patient stroke risk prior to TAVR.