Pre-procedural assessment of aortic annulus dimensions for transcatheter aortic valve replacement: comparison of a non-contrast 3D MRA protocol with contrast-enhanced cardiac dual-source CT angiography
Pre-procedural assessment of aortic annulus dimensions for transcatheter aortic valve replacement: comparison of a non-contrast 3D MRA protocol with contrast-enhanced cardiac dual-source CT angiography
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DOI：
10.1093/ehjci/jev188
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发表时间：
2016-04-01
影响因子：
6.2
通讯作者：
Pache, Gregor
中科院分区：
文献类型：
--
作者：
Ruile, Philipp;Blanke, Philipp;Pache, Gregor
目的：与心脏双源计算机断层扫描血管造影（CTA）相比，评价非造影三维（3D）-FLASH磁共振血管造影（MRA）方案用于经导管主动脉瓣置换术（TAVR）术前主动脉瓣环评估的可行性。方法和结果在这项前瞻性研究中，104例连续患者中有69例（平均年龄81.8 +/- 5.4岁，37.7%的患者）患有重度主动脉瓣狭窄，接受了TAVR前心脏CTA，在3 T下接受了呼吸和ECG触发的非造影3D-FLASH MRA。两种模式的瓣环面积测量均在中瓣口处获得，而最大收缩面积仅通过CTA评估。通过添加收缩期和舒张期CTA面积尺寸的相对差异作为校正因子，对SyringMRA尺寸进行建模。根据收缩期CTA、舒张期和建模的收缩期MRA面积测量值进行假设性假体尺寸测量。MR图像质量和环形钙化程度采用4分分级法进行评价。平均采集时间为14 +/- 4.2 min。平均图像质量为3.1 +/- 0.9，只有两次检查被评定为非诊断性。平均钙化程度相等。根据Bland-Altman分析评估，模型化收缩期MRA和收缩期CTA的面积测量值之间没有相关的系统差异[平均差异23.1 mm（2）（一致性限值244.4 mm（2）; 38.2 mm（2）]。67例患者中有63例（94%）在收缩期CTA和建模收缩期MRA中发现了假设假体尺寸的一致性。结论所采用的非造影剂3D-FLASH MRA协议即使在所有患者的TAVR前人群中存在心律失常时也可以可靠地评估主动脉瓣环尺寸和钙化。在造影剂肾病风险增加的患者中实施该技术似乎是合理的。
Aims To evaluate the feasibility of a non-contrast three-dimensional (3D)-FLASH magnetic resonance angiography (MRA) protocol for pre-procedural aortic annulus assessment for transcatheter aortic valve replacement (TAVR) in comparison with cardiac dual-source computed tomography angiography (CTA).Methods and results In this prospective study, 69 of 104 consecutive patients (mean age 81.8 +/- 5.4 years, 37.7% arrhythmic) with severe aortic stenosis who had undergone pre-TAVR cardiac CTA received a respiratory and ECG-triggered, non-contrast 3D-FLASH MRA at 3 T. Annular area measurements were obtained at mid-diastole for both modalities whereas maximum systolic area was assessed by CTA only. Systolic MRA dimensions were modelled, by adding the relative difference of systolic and diastolic CTA area dimensions as a corrective factor. Hypothetical prosthesis sizing was performed based on systolic CTA, diastolic, and modelled systolic MRA area measurements. MR image quality and degree of annular calcifications were evaluated using 4-point-grading scales. The mean acquisition time was 14 +/- 4.2 min. The mean image quality was 3.1 +/- 0.9 with only two examinations rated non-diagnostic. The mean degree of calcifications was equal. As assessed by Bland-Altman analysis, there was no relevant systematic difference between area measurements for modelled systolic MRA and systolic CTA [the mean difference 23.1 mm(2) (limits of agreement 244.4 mm(2); 38.2 mm(2))]. Agreement for hypothetical prosthesis sizing was found in 63 of 67 (94%) patients for systolic CTA and modelled systolic MRA.Conclusion The employed non-contrast 3D-FLASH MRA protocol allows for reliable assessment of aortic annulus dimensions and calcifications even in the presence of arrhythmias in an all-comers pre-TAVR population. Implementation of this technique appears legitimate in patients at an increased risk for contrast-induced nephropathy.