Prognostic Value of Computed Tomography-Derived Extracellular Volume in TAVR Patients With Low-Flow Low-Gradient Aortic Stenosis.
Prognostic Value of Computed Tomography-Derived Extracellular Volume in TAVR Patients With Low-Flow Low-Gradient Aortic Stenosis.
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DOI：
10.1016/j.jcmg.2020.07.045
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Makkar R
中科院分区：
文献类型：
--
作者：
Tamarappoo B;Han D;Tyler J;Chakravarty T;Otaki Y;Miller R;Eisenberg E;Singh S;Shiota T;Siegel R;Stegic J;Salseth T;Cheng W;Dey D;Thomson L;Berman D;Friedman J;Makkar R
低流量低梯度AS （LFLG）患者在临床预后方面属于高危人群。虽然细胞外体积（ECV）是心肌纤维化的一个标志，传统上是用心脏磁共振成像来测量的，但它也可以用心脏CT血管造影（CTA）来测量。我们假设在LFLG AS中，ECV升高可能与不良临床结果相关。我们评估了经导管主动脉瓣置换术（TAVR）的LFLG AS患者CTA测量的ECV与临床结果之间的关系。在150例接受TAVR的LFLG AS患者中，使用TAVR前CTA量化ECV。从电子病历中获取超声心动图和临床信息，包括全因死亡和心力衰竭再住院（HFH）。采用Cox比例风险模型评价ECV与死亡+HFH的相关性。在中位随访13.9个月（0.07-28.9个月）期间，有31例死亡+HFH（21%）。与未经历死亡+HFH的患者相比，经历死亡+HFH的患者胸外科学会评分中位数更高（4.7 vs 9.9, p<0.01），左心室射血分数较低（42.3±20.2% vs 52.7±17.2%,p<0.01），平均经瓣梯度较低（24.9±8.9mmHg vs 28.1±7.3mmHg, p=0.04），平均ECV升高（35.5±9.6% vs 29.9±8.2%,p<0.01）。在多变量cox比例风险模型中，ECV的增加与死亡率和HFH的增加相关（每增加1%的风险比=1.04,95% CI=1.01 - 1.09, p<0.01）。在LFLG AS患者中，CTA测量的ECV增加与tavr后不良临床结果的风险增加相关，因此可以作为一种有用的无创预后标志物。
Patients with low-flow low-gradient (LFLG) AS comprise a high-risk group with respect to clinical outcomes. Although extracellular volume (ECV), a marker of myocardial fibrosis, is traditionally measured with cardiac magnetic resonance imaging, it can also be measured using cardiac CT angiography (CTA). We hypothesized that in LFLG AS, increased ECV may be associated with adverse clinical outcomes. We evaluated the association between ECV measured by CTA and clinical outcomes in LFLG AS patients undergoing transcatheter aortic valve replacement (TAVR). In 150 LFLG AS patients who underwent TAVR, ECV was quantified using pre-TAVR CTA. Echocardiographic and clinical information including all cause death and heart failure rehospitalization (HFH) was obtained from electronic medical records. A Cox proportional hazards model was used to evaluate the association between ECV and death+HFH. During a median follow-up of 13.9 months (range 0.07–28.9) there were 31 death+HFH (21%). Patients who experienced death+HFH had a greater median Society of Thoracic Surgery score (4.7 vs 9.9, p<0.01), lower left ventricular ejection fraction (42.3±20.2% vs 52.7±17.2%, p<0.01), lower mean transvalvular gradient (24.9±8.9mmHg vs 28.1±7.3mmHg, p=0.04) and increased mean ECV (35.5±9.6% vs. 29.9±8.2%, p<0.01) compared to patients who did not experience death+HFH. In a multivariable cox proportional hazards model, increase in ECV was associated with increase in death+HFH, (hazard ratio per 1% increase=1.04, 95% CI=1.01– 1.09, p<0.01). In patients with LFLG AS, CTA measured increase in ECV is associated with increased risk of adverse clinical outcomes post-TAVR and may thus serve as a useful noninvasive marker for prognostication.
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DOI：
10.1016/j.jtcvs.2012.09.002
发表时间：
2013-01-01
影响因子：
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作者：
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DOI：
10.1016/j.jcmg.2016.10.007
发表时间：
2017-11
期刊：
JACC. Cardiovascular imaging
影响因子：
--
作者：
Chin CWL;Everett RJ;Kwiecinski J;Vesey AT;Yeung E;Esson G;Jenkins W;Koo M;Mirsadraee S;White AC;Japp AG;Prasad SK;Semple S;Newby DE;Dweck MR
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