由多层螺旋CT确定的血流梯度组能预测结果吗?

Faisal Rahman, Pallavi Pandey, Ankur Pandey, Matthew J Czarny, Jelani Grant, Stefan L Zimmerman
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摘要

背景:识别严重的主动脉狭窄是很困难的,特别是与正常血流相比,低血流状态的患者。非侵入性模式可以帮助诊断和及时治疗。方法:在这项回顾性的单中心研究中,我们对经导管主动脉瓣置换术(TAVR)的主动脉瓣狭窄患者进行了回顾性研究,我们使用基于CT血池(CT-blp)分析、超声心动图和TAVR前的右心导管(cath)来计算卒中容量。我们比较了每种模式在预测30天和1年预后方面的表现。结果:纳入345例患者,中位年龄84岁(79 ~ 88岁),女性占52.8%。CT-blp与导管衍生脑卒中容量的相关性(r = 0.60)高于echo (r = 0.37)。在使用回声或CT-blp根据流量和梯度将患者分层后,两种方式在组间的死亡率均无差异。然而,低流量低梯度组的死亡率和再入院率的组合明显更高(CT-blp 30天OR 2.6, 95% CI 1.3-5.3, p)。结论:利用tavr前患者的CT检查,CT-blp可以提供卒中容量的估计,与有创评估有很好的相关性。当回声受限时,脑卒中容积可用于将TAVR评估的患者人群分层为血流梯度组,避免侵入性置管,以帮助识别低血流、低梯度主动脉瓣狭窄患者。需要更大规模的进一步研究来证实我们的发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do flow-gradient groups determined by MDCT predict outcomes: validating CT stroke volume.

Background: Identifying severe aortic stenosis can be difficult especially among patients with low-flow states compared to normal flow. Non-invasive modalities can aid in the diagnosis for timely treatment.

Methods: In this retrospective, single-center study of patients with aortic stenosis who underwent transcatheter aortic valve replacement (TAVR), we calculated stroke volume using CT blood pool based (CT-blp) analysis, echocardiogram and right heart catheterization (cath) performed before TAVR. We compared the performance of each modality in predicting 30-day and 1-year outcomes.

Results: Three-hundred and forty-five patients were included with a median age of 84 (79-88) years and 52.8% females. CT-blp correlated more strongly (r = 0.60) with cath-derived stroke volume than echo (r = 0.37). After stratifying patients into groups based on flow and gradient using echo or CT-blp, there was no difference in mortality with either modality among the groups. However, the composite of mortality and hospital readmission was significantly higher in the low-flow low-gradient group (CT-blp 30-day OR 2.6, 95% CI 1.3-5.3, p < 0.01; 1-year OR 1.9, 95% CI 1.0-3.6; p = 0.04) compared to patients with normal flow high gradients when grouping was performed with CT-blp or echo.

Conclusion: Using the CT performed on patients pre-TAVR, CT-blp can provide an estimation of stroke volume that correlates well with invasive evaluation. The stroke volume may be used to stratify patient populations being evaluated for TAVR into flow gradient groups when echo is limited and avoid invasive catheterization to help identify patients with low-flow, low-gradient aortic stenosis. Further studies with larger cohorts are required to confirm our findings.

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