接受经导管主动脉瓣植入术的患者的辐射暴露及其诱因

IF 2.9 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
M Farrugia, D J Foulkes
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The study of exposure to ionising radiation in the TAVI population is becoming progressively more important to consider due to the broader population being considered and the long-term effects related to radiation. Purpose Locally there was no data available covering this topic, thus the aim of the study was to quantify the radiation dose that patients receive during TAVI procedures and to determine any procedural and patient factors that contribute to this radiation dose. Methods Retrospective data analysis was performed for procedures effected between January 2019 and December 2022. All the patients that underwent a transfemoral (TF) TAVI and fit within the inclusion criteria were included in the study. The data was collected from medical databases and underwent a process of data cleaning before information relating to patient and procedural characteristics was extracted. Data about percutaneous coronary interventions (PCI) that were performed during the same time period by the same operators was collected for comparison purposes. Results In total the data of 241 TAVI patients was analysed. Dose Area Product (DAP) was the main radiation metric utilised to quantify the radiation dose. Non-parametric statistical tests were performed due to right-skewedness. The median (IQR) DAP for these procedures was 9000 cGym2 (5975-13150) and the median (IQR) fluoroscopy time was 18.25 minutes (15, 23.5). The years 2019 and 2020 had the lowest median DAP. The DAP obtained in this study is lower than the European DRLs of 13000 cGym2. The median (IQR) DAP (5320cGym2 (2385-9860)), and fluoroscopy time (13.75 mins (8.25-21.62)) for PCIs were lower than for TAVI and this difference is statistically significant (P = <0.001). DAP was not significantly related only to age category and the operator’s combination. 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引用次数: 0

摘要

背景/导言 主动脉瓣狭窄(AS)是一种影响主动脉瓣叶的钙化性疾病,常见于 65 岁及以上的老年人。由于预期寿命的延长以及与该疾病相关的发病率和死亡率,预计主动脉瓣狭窄的全球负担将不断增加。经导管主动脉瓣植入术可用于治疗强直性脊柱炎。目前,TAVI 被推荐作为 75 岁及以上患者和中高手术风险患者的一线治疗方案,并有望成为 65 岁及以上患者的首选治疗方案。然而,TAVI 的一个令人担忧的问题是在瓣膜置入过程中需要电离辐射。由于 TAVI 考虑的人群更广,而且与辐射相关的长期影响也更大,因此对 TAVI 患者电离辐射暴露的研究变得越来越重要。因此,本研究旨在量化患者在 TAVI 手术中接受的辐射剂量,并确定导致辐射剂量的手术因素和患者因素。方法 对 2019 年 1 月至 2022 年 12 月期间实施的手术进行回顾性数据分析。所有接受经股(TF)TAVI且符合纳入标准的患者均纳入研究。数据从医疗数据库中收集,在提取与患者和手术特征相关的信息之前进行了数据清理。为便于比较,还收集了同一时期由同一操作者实施的经皮冠状动脉介入治疗(PCI)的数据。结果 共分析了 241 名 TAVI 患者的数据。剂量面积乘积(DAP)是量化辐射剂量的主要辐射指标。由于存在右偏性,因此进行了非参数统计检验。这些手术的剂量面积积中位数(IQR)为 9000 cGym2(5975-13150),透视时间中位数(IQR)为 18.25 分钟(15,23.5)。2019 年和 2020 年的 DAP 中位数最低。本研究获得的 DAP 低于欧洲 13000 cGym2 的 DRL。PCI的DAP中位数(IQR)(5320cGym2 (2385-9860))和透视时间(13.75分钟 (8.25-21.62))均低于TAVI,这一差异具有统计学意义(P = <0.001)。DAP仅与年龄类别和术者组合无明显关系。广义线性模型(GLM)显示,人工瓣膜的大小、体表面积(BSA)和主动脉瓣梯度对 DAP 的预测具有统计学意义。结论 该研究表明,当地 TAVI 患者接受的辐射剂量在欧洲可接受范围内,瓣膜大小和患者体表面积是影响辐射剂量的变量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Radiation exposure of patients undergoing transcatheter aortic valve implantation and factors contributing to it
Background/ Introduction Aortic stenosis (AS) is a calcific disease which affects the aortic valve leaflets and is commonly prevalent in people who are 65 years and older. The global burden of AS is expected to keep on increasing due to the longer life expectancy as well as the morbidity and mortality associated with the disease. Transcatheter aortic valve implantation is utilised for the management of AS. Currently, TAVI is recommended as a first-line treatment for patients who are 75 years and older and those who are at an intermediate to high surgical risk, with the aim of becoming the first treatment option for patients who are 65 years and older. However, one of the concerns of TAVI is the need of ionising radiation during valve placement. The study of exposure to ionising radiation in the TAVI population is becoming progressively more important to consider due to the broader population being considered and the long-term effects related to radiation. Purpose Locally there was no data available covering this topic, thus the aim of the study was to quantify the radiation dose that patients receive during TAVI procedures and to determine any procedural and patient factors that contribute to this radiation dose. Methods Retrospective data analysis was performed for procedures effected between January 2019 and December 2022. All the patients that underwent a transfemoral (TF) TAVI and fit within the inclusion criteria were included in the study. The data was collected from medical databases and underwent a process of data cleaning before information relating to patient and procedural characteristics was extracted. Data about percutaneous coronary interventions (PCI) that were performed during the same time period by the same operators was collected for comparison purposes. Results In total the data of 241 TAVI patients was analysed. Dose Area Product (DAP) was the main radiation metric utilised to quantify the radiation dose. Non-parametric statistical tests were performed due to right-skewedness. The median (IQR) DAP for these procedures was 9000 cGym2 (5975-13150) and the median (IQR) fluoroscopy time was 18.25 minutes (15, 23.5). The years 2019 and 2020 had the lowest median DAP. The DAP obtained in this study is lower than the European DRLs of 13000 cGym2. The median (IQR) DAP (5320cGym2 (2385-9860)), and fluoroscopy time (13.75 mins (8.25-21.62)) for PCIs were lower than for TAVI and this difference is statistically significant (P = <0.001). DAP was not significantly related only to age category and the operator’s combination. Generalised linear models (GLM) showed that prosthetic valve size, body surface area (BSA) and aortic valve gradient are statistically significant predictors of DAP. Conclusion This study shows that the local TAVI patients receive a radiation dose which is within acceptable European limits and that valve size and patient’s BSA are the variables that impacted the radiation dose.
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来源期刊
European Journal of Cardiovascular Nursing
European Journal of Cardiovascular Nursing CARDIAC & CARDIOVASCULAR SYSTEMS-NURSING
CiteScore
5.10
自引率
10.30%
发文量
247
审稿时长
6-12 weeks
期刊介绍: The peer-reviewed journal of the European Society of Cardiology’s Council on Cardiovascular Nursing and Allied Professions (CCNAP) covering the broad field of cardiovascular nursing including chronic and acute care, cardiac rehabilitation, primary and secondary prevention, heart failure, acute coronary syndromes, interventional cardiology, cardiac care, and vascular nursing.
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