Alexandra Steyer, Valentina O Puntmann, Eike Nagel, David M Leistner, Vitali Koch, Mariuca Vasa-Nicotera, Parveen Kumar, Christian Booz, Thomas J Vogl, Silvia Mas-Peiro, Simon S Martin
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Abstract
Purpose To examine the clinical feasibility of workstation-based CT fractional flow reserve (CT-FFR) for coronary artery disease (CAD) evaluation during preprocedural planning in patients undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods In this retrospective single-center study, 434 patients scheduled for TAVR between 2018 and 2020 were screened for study inclusion; a relevant proportion of patients (35.0% [152 of 434]) was not suitable for evaluation due to insufficient imaging properties. A total of 112 patients (mean age, 82.1 years ± 6.7 [SD]; 58 [52%] men) were included in the study. Invasive angiography findings, coronary CT angiography results, and Agatston score were acquired and compared with on-site CT-FFR computation for evaluation of CAD and prediction of major adverse cardiovascular events (MACE) within a 24-month follow-up. Results Hemodynamic relevant CAD, as suggested by CT-FFR of 0.80 or less, was found in 41 of 70 (59%) patients with stenosis of 50% or more. MACE occurred in 23 of 112 (20.5%) patients, from which 14 of 23 had stenoses with CT-FFR of 0.80 or less (hazard ratio [HR], 3.33; 95% CI: 1.56, 7.10; P = .002). CT-FFR remained a significant predictor of MACE after inclusion in a multivariable model with relevant covariables (HR, 2.89; 95% CI: 1.22, 6.86; P = .02). An Agatston score of 1000 Agatston units or more (HR, 2.25; 95% CI: 0.98, 5.21; P = .06) and stenoses of 50% or more determined via invasive angiography (HR, 0.94; 95% CI: 0.41, 2.17; P = .88) were not significant predictors of MACE. Conclusion Compared with conventional CAD markers, CT-FFR better predicted adverse outcomes after TAVR. A relevant portion of the screened cohort, however, was not suitable for CT-based CAD evaluation. Keywords: CT, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Coronary Arteries, Outcomes Analysis © RSNA, 2024 See also the commentary by Weir-McCall and Pugliese in this issue.
通过现场 CT 分数血流储备评估接受经导管主动脉瓣置换术患者的冠状动脉疾病。
目的 探讨在接受经导管主动脉瓣置换术(TAVR)的患者进行术前规划时,基于工作站的 CT 分数血流储备(CT-FFR)用于冠状动脉疾病(CAD)评估的临床可行性。材料与方法 在这项回顾性单中心研究中,筛选了 2018 年至 2020 年期间计划接受 TAVR 的 434 例患者作为研究对象;由于成像特性不足,有一定比例的患者(35.0% [434 例中的 152 例])不适合接受评估。共有 112 名患者(平均年龄 82.1 岁 ± 6.7 [SD];男性 58 [52%])被纳入研究。研究人员获取了有创血管造影结果、冠状动脉 CT 血管造影结果和 Agatston 评分,并将其与现场 CT-FFR 计算结果进行比较,以评估 CAD 和预测 24 个月随访期间的主要不良心血管事件 (MACE)。结果 在 70 名血管狭窄程度达到或超过 50%的患者中,有 41 人(59%)发现了血流动力学相关的 CAD(CT-FFR 为 0.80 或更低)。112名患者中有23名(20.5%)发生了MACE,其中14名患者的血管狭窄程度为CT-FFR 0.80或以下(危险比[HR],3.33;95% CI:1.56,7.10;P = .002)。在纳入包含相关协变量的多变量模型后,CT-FFR仍是MACE的重要预测因素(HR,2.89;95% CI:1.22,6.86;P = .02)。Agatston评分达到或超过1000 Agatston单位(HR,2.25;95% CI:0.98,5.21;P = .06)以及通过有创血管造影确定的血管狭窄达到或超过50%(HR,0.94;95% CI:0.41,2.17;P = .88)并不能显著预测MACE。结论 与传统的 CAD 标志物相比,CT-FFR 更能预测 TAVR 后的不良预后。然而,在接受筛查的人群中,有相当一部分人不适合进行基于 CT 的 CAD 评估。关键词CT、经导管主动脉瓣植入/置换术(TAVI/TAVR)、心脏、冠状动脉、结果分析 © RSNA, 2024 另请参阅本期 Weir-McCall 和 Pugliese 的评论。
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