Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study
Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study
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DOI：
10.1186/1532-429x-13-82
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发表时间：
2011-12-27
影响因子：
6.4
通讯作者：
Tamburino, Corrado
中科院分区：
文献类型：
--
作者：
La Manna, Alessio;Sanfilippo, Alessandra;Tamburino, Corrado
背景资料：在经导管主动脉瓣植入术（TAVI）之前，评估心脏功能和准确测量主动脉根部是确定正确尺寸和类型的人工瓣膜的关键。本研究的目的是比较心血管磁共振（CMR）和经胸超声心动图（TTE）在评估接受TAVI的高危老年患者的主动脉瓣测量和左心室功能方面的差异。方法：从2009年4月至2011年1月，对患有严重主动脉瓣狭窄和外科主动脉瓣置换术禁忌症的连续患者进行筛选，并进行TTE成像，结果：接受TTE和CMR的患者（n = 49）的平均年龄为80.8 ± 4.8岁，平均logistic EuroSCORE为14.9 ± 9.3%。TTE和CMR在瓣环大小方面具有良好的相关性（R-2 = 0.48，p < 0.001），左心室流出道（LVOT）直径（R-2 = 0.62，p < 0.001）和左心室射血分数（LVEF）（R-2 = 0.47，p < 0.001）和主动脉瓣面积（AVA）中度相关（R-2 = 0.24，p < 0.001）。对于所有测量，CMR通常倾向于报告比TTE更大的值。Bland-Altman检验表明，TTE和CMR之间的95%一致性限值范围为：瓣环尺寸为-5.6 mm至+ 1.0 mm，LVOT为-0.45 mm至+ 0.25 mm，AVA为-0.45 mm（2）至+ 0.25 mm 2，LVEF为-29.2%至13.2%。在TAVI的老年患者中，CMR是经胸超声心动图的可行补充。
Background: Before trans-catheter aortic valve implantation (TAVI), assessment of cardiac function and accurate measurement of the aortic root are key to determine the correct size and type of the prosthesis. The aim of this study was to compare cardiovascular magnetic resonance (CMR) and trans-thoracic echocardiography (TTE) for the assessment of aortic valve measurements and left ventricular function in high-risk elderly patients submitted to TAVI.Methods: Consecutive patients with severe aortic stenosis and contraindications for surgical aortic valve replacement were screened from April 2009 to January 2011 and imaged with TTE and CMR.Results: Patients who underwent both TTE and CMR (n = 49) had a mean age of 80.8 +/- 4.8 years and a mean logistic EuroSCORE of 14.9 +/- 9.3%. There was a good correlation between TTE and CMR in terms of annulus size (R-2 = 0.48, p < 0.001), left ventricular outflow tract (LVOT) diameter (R-2 = 0.62, p < 0.001) and left ventricular ejection fraction (LVEF) (R-2 = 0.47, p < 0.001) and a moderate correlation in terms of aortic valve area (AVA) (R-2 = 0.24, p < 0.001). CMR generally tended to report larger values than TTE for all measurements. The Bland-Altman test indicated that the 95% limits of agreement between TTE and CMR ranged from -5.6 mm to + 1.0 mm for annulus size, from -0.45 mm to + 0.25 mm for LVOT, from -0.45 mm(2) to + 0.25 mm2 for AVA and from -29.2% to 13.2% for LVEF.Conclusions: In elderly patients candidates to TAVI, CMR represents a viable complement to transthoracic echocardiography.