Extent and distribution of calcification of both the aortic annulus and the left ventricular outflow tract predict aortic regurgitation after transcatheter aortic valve replacement
Extent and distribution of calcification of both the aortic annulus and the left ventricular outflow tract predict aortic regurgitation after transcatheter aortic valve replacement
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DOI：
10.4244/eijv10i6a126
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发表时间：
2014-10-01
期刊：
影响因子：
6.2
通讯作者：
Windecker, Stephan
中科院分区：
文献类型：
--
作者：
Buellesfeld, Lutz;Stortecky, Stefan;Windecker, Stephan
目的：我们试图分析局部分布的主动脉瓣环和左心室流出道（LVOT）钙化的患者接受经导管主动脉瓣置换术（TAVR）和其对主动脉瓣反流（AR）的影响后，立即装置placement.Methods和结果：一组177例严重主动脉瓣狭窄的患者接受多层螺旋CT的主动脉根部，然后TAVR入组本单中心研究。使用半定量分级系统评估每个瓣尖的瓣环和LVOT钙化（0：无; 1 [轻度]：小的、非突出钙化; 2 [中度]：突出[>1 mm]或广泛[>50%的瓣尖扇区]钙化; 3 [重度]：突出和广泛钙化）。分别有107例（61%）和63例（36%）患者存在瓣环或LVOT的任何钙化。左冠状动脉尖瓣环/LVOT钙化的发生率分别为42%和25%，非冠状动脉尖瓣环/LVOT钙化的发生率分别为28%和13%，右冠状动脉尖瓣环/LVOT钙化的发生率分别为13%和5%。在55名患者（31%）中观察到TAVR器械植入后即刻通过Sellers方法评估的AR 2 - 4级。多变量回归分析显示，总体瓣环钙化（OR [95%CI] 1.48 [1.10-2.00]; p=0.0106），总体LVOT钙化（1.93 [1.26-2.96]; p=0.0026），任何中度或重度LVOT钙化（5.37 [1.52-18.99]; p=0.0092）和不对称LVOT钙化是AR的独立预测因素。主动脉瓣环和LVOT钙化在接受TAVR的患者中很常见，钙化的分布和严重程度似乎是器械植入后主动脉瓣返流的独立预测因素。
Aims: We sought to analyse local distribution of aortic annulus and left ventricular outflow tract (LVOT) calcification in patients undergoing transcatheter aortic valve replacement (TAVR) and its impact on aortic regurgitation (AR) immediately after device placement.Methods and results: A group of 177 patients with severe aortic stenosis undergoing multislice computed tomography of the aortic root followed by TAVR were enrolled in this single-centre study. Annular and LVOT calcifications were assessed per cusp using a semi-quantitative grading system (0: none; 1 [mild]: small, non-protruding calcifications; 2 [moderate]: protruding [>1 mm] or extensive [>50% of cusp sector] calcifications; 3 [severe]: protruding and extensive calcifications). Any calcification of the annulus or LVOT was present in 107 (61%) and 63 (36%) patients, respectively. Prevalence of annulus/LVOT calcifications in the left coronary cusp was 42% and 25%, respectively, in the non-coronary cusp 28% and 13%, in the right coronary cusp 13% and 5%. AR grade 2 to 4 assessed by the method of Sellers immediately after TAVR device implantation was observed in 55 patients (31%). Multivariate regression analysis revealed that the overall annulus calcification (OR [95% CI] 1.48 [1.10-2.00]; p=0.0106), the overall LVOT calcification (1.93 [1.26-2.96]; p=0.0026), any moderate or severe LVOT calcification (5.37 [1.52-18.99]; p=0.0092), and asymmetric LVOT calcification were independent predictors of AR.Conclusions: Calcifications of the aortic annulus and LVOT are frequent in patients undergoing TAVR, and both the distribution and the severity of calcifications appear to be independent predictors of aortic regurgitation after device implantation.