The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement
The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement
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DOI：
10.1016/j.jcct.2015.04.002
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发表时间：
2015-09-01
影响因子：
5.4
通讯作者：
Leipsic, Jonathon
中科院分区：
文献类型：
--
作者：
Hansson, Nicolaj C.;Norgaard, Bjarne L.;Leipsic, Jonathon
背景：对主动脉根部钙的详细评估可能会为经导管心脏瓣膜置换术(TAVR)中主动脉根部损伤的风险提供重要的补充信息。目的：我们试图描述在TAVR中钙的体积和分布对主动脉根部损伤的影响。方法：33例在TAVR期间有主动脉根部损伤的患者与153名连续的无主动脉根部损伤的TAVR患者(由TAVR后多层螺旋CT评估)进行比较。使用商业软件分析增强前TAVR CT扫描，确定了3个区域的钙化体积：(1)总的左室流出道(LVOT)，从主动脉环平面向下延伸10 mm；(2)上左室流出道，从主动脉环平面向下延伸2 mm；(3)主动脉瓣区域。P=.0001)，与对照组相比，主动脉根部损伤的患者更高。主动脉瓣膜区域的钙含量在不同组之间没有差异。上LVOT钙容量比整体LVOT钙容量更能预测主动脉根部损伤(受试者工作曲线下面积[8月]；0.78；95%可信区间，0.69-0.86 vs AUC，0.71；95%可信区间，0.62-0.82；P=.010)。与右冠脉或左冠状动脉尖下的钙相比，非冠脉尖下的左冠状动脉上段钙显著更能预测主动脉根部损伤(AUC，0.81比0.68比0.64)。假体尺寸过大20%(似然比检验，P=.028)和再扩张(似然比检验，P=.015)改善了左心室流出道上部钙容量对主动脉根部损伤的预测。结论：左心室流出道钙化，尤其是左心室流出道上部钙化，位于非冠脉尖部以下，从环状区延伸，是TAVR术中主动脉根部损伤的预测指标。(C)2015年心血管计算机断层扫描学会。版权所有。
Background: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR).Objective: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR.Methods: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, caltium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region.Results: Calcium volumes in the upper LVOT (median, 29 vs 0 mm(3); P < .0001) and overall LVOT (median, 74 vs 3 mm(3); P = .0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUG]; 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P = .010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P = .028) and redilatation (likelihood ratio test, P = .015) improved prediction of aortic root injury by upper LVOT calcium volume.Conclusion: Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve. (C) 2015 Society of Cardiovascular Computed Tomography. All rights reserved.