Peridevice Leak Following Amplatzer Left Atrial Appendage Occlusion Cardiac Computed Tomography Classification and Clinical Outcomes
Peridevice Leak Following Amplatzer Left Atrial Appendage Occlusion Cardiac Computed Tomography Classification and Clinical Outcomes
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DOI：
10.1016/j.jcin.2020.10.034
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发表时间：
2021-01-04
影响因子：
11.3
通讯作者：
Nielsen-Kudsk, Jens Erik
中科院分区：
文献类型：
--
作者：
Korsholm, Kasper;Jensen, Jesper Moller;Nielsen-Kudsk, Jens Erik
目的本研究旨在探讨心脏计算机断层扫描（CT）和经食管超声心动图（TEE）围装置泄漏（PDL）的评估，以及PDL的临床意义。背景：左心耳（LAA）闭塞后的随访中，PDL评估是不可或缺的。TEE与心脏CT的比较研究较少，PDL的临床相关性也不确定。方法：本研究是一项单中心观察性研究，纳入2010年至2018年间连续使用Amplatzer装置（Amplatzer Cardiac Plug/Amulet）进行LAA闭塞的患者（N = 415）。同时进行8周CT和TEE检查的患者纳入分析（n = 346）。图像由盲法研究者（K.K.和A.S.）分析。根据装置盘、装置叶的PDL及LAA造影剂通畅程度，心脏CT上PDL分为1 ~ 3级。主要临床结果是缺血性卒中、短暂性缺血性发作、全身性栓塞或全因死亡的综合结果。结果TEE患者中有110例（32%）出现PDL，其中29例（8%）出现bbb30 mm。通过心脏CT， 210例患者（61%）在椎间盘处有PDL， 204例患者（59%）有造影剂通畅。63例（18%）患者出现3级PDL（椎间盘、肺叶间隙和LAA造影剂通畅）。Bland-Altman分析显示CT和TEE对泄漏大小的判断不一致。CT和TEE检测到的PDL与预后较差无显著相关，风险比：1.82(95%可信区间：0.95 ~ 3.50)；P = 0.07，风险比：1.43(95%可信区间：0.74 ~ 2.76)；P = 0.28。结论CT与TEE相比，PDL的发生率明显更高，但两种方法在泄漏量化方面存在较大差异。提出了一种新的基于ct的分类，但PDL与较差的临床结果无关。(C) 2021年由美国心脏病学会基金会发布。
OBJECTIVES This study aimed to investigate cardiac computed tomography (CT) and transesophageal echocardiography (TEE) peridevice leak (PDL) assessments, and the clinical relevance of PDL.BACKGROUND PDL assessment is integral during follow-up after left atrial appendage (LAA) occlusion. Comparative studies of TEE and cardiac CT are sparse, and the clinical relevance of PDL is uncertain.METHODS This was a single-center observational study of consecutive patients undergoing LAA occlusion with Amplatzer devices (Amplatzer Cardiac Plug/Amulet) between 2010 and 2018 (N = 415). Patients with both 8-week CT and TEE were included for analysis (n = 346). Images were analyzed by blinded investigators (K.K. and A.S.). PDL on cardiac CT was classified from grade 1 to 3, based on PDL at the device disc, device lobe, and LAA contrast patency. Primary clinical outcome was a composite of ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death.RESULTS PDL was present in 110 patients (32%) by TEE, with 29 (8%) >3 mm. By cardiac CT, 210 patients (61%) had PDL at the disc, with contrast patency in 204 patients (59%). A grade 3 PDL (gap at disc, lobe, and LAA contrast patency) was present in 63 patients (18%). Bland-Altman analysis showed poor agreement between CT and TEE for leak sizing. CT and TEE detected PDL was not significantly associated with worse outcome, hazard ratio: 1.82 (95 % confidence interval: 0.95 to 3.50); p = 0.07 and hazard ratio: 1.43 (95% confidence interval: 0.74 to 2.76); p = 0.28, respectively.CONCLUSIONS PDL occurrence is substantially higher with CT compared with TEE, with a large discrepancy between modalities in leak quantification. A novel CT-based classification is proposed, yet PDL was not associated with worse clinical outcome. (C) 2021 by the American College of Cardiology Foundation.