TAVI患者的形态学和钙化特征:一项3D统计形状建模研究。

IF 7.7
PLOS digital health Pub Date : 2025-07-21 eCollection Date: 2025-07-01 DOI:10.1371/journal.pdig.0000564
Raphaël Sivera, Ebba Montgomery-Liljeroth, Yaxi Chen, Silvia Schievano, Jan Brüning, Wouter Huberts, Anthony Mathur, Andrew Cook, Kush Patel, Claudio Capelli
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引用次数: 0

摘要

主动脉瓣狭窄(Aortic stenosis, AS)是一种常见的瓣膜疾病,由于人口老龄化,在全球范围内变得越来越普遍。经导管主动脉瓣植入术(TAVI)是一种微创干预,适用于AS患者,可替代手术置换。迄今为止,TAVI是一个既定的程序。然而,它常伴有瓣旁漏(PVL)或传导异常等并发症。有证据表明,主动脉根部形态学特征、瓣膜钙化测量和次优手术结果之间存在关联,但分析受到临床测量的可获得性和可重复性的限制。在这项工作中,我们的目的是通过分析临床表现,结合植入部位的高级形态学分析,包括主动脉根、左心室流出道和3D钙化模式,丰富AS患者TAVI的特征。本研究回顾性选择了在我们临床中心连续接受TAVI治疗的AS患者(n = 130)。在TAVI前后收集了人口统计学和临床测量数据。术前CT图像用于重建患者特定解剖结构的3D模型。进行统计形状建模,并结合临床结果对结果进行分析。瓣膜钙化率的三维建模与既往临床描述相符;包括每个小叶上可见的新月形和非冠状动脉尖较高的钙化率。瓣膜越大,钙化率越高,各冠状动脉高度与其各自小叶钙化程度呈正相关。两性二态性,在形状和钙化方面,除了在大小上的差异外,男性的主动脉更直,左右冠状动脉小叶交界处的钙化率更高。形态学差异与基于术后超声心动图的PVL评估显著相关(p = 0.005)。较大的主动脉和较短的左冠状动脉窦与较少的泄漏相关。结果分布似乎直接受到性别差异和器械设计的影响。女性表型,更小和更锥形的主动脉根,与较差的结果相关。在小叶钙化分布的不同模式被确定,但与结果的关系是不确定的。在未来,AS患者的形态学特征可以帮助预测TAVI后PVL,设计和测试改进的TAVI装置。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Morphology and calcification characterization in patients undergoing TAVI: A 3D statistical shape modelling study.

Aortic stenosis (AS) is a common valvular disease becoming more prevalent globally due to the aging of the population. Transcatheter aortic valve implantation (TAVI) is a minimally invasive intervention indicated for AS patients as alternative to surgical replacement. TAVI is to date an established procedure. However, it has been often associated with complications such as paravalvular leakage (PVL) or conduction abnormalities. Evidence of associations between morphological features of the aortic root, valve calcification measurements and suboptimal procedural outcomes have been suggested but the analyses were limited by availability and reproducibility of clinical measurements. In this work, we aim to enrich the characterization of AS patients referred for TAVI by analyzing the clinical findings in conjunction with advanced morphological analysis of the implantation site including aortic root, left ventricular outflow tract and 3D calcification patterns. A population of consecutive patients with AS (n = 130) who underwent TAVI at our clinical centre were retrospectively selected for this study. Demographic and clinical measurements were collected before and after TAVI. Pre-operative CT images were used to reconstruct 3D models of patient-specific anatomies. Statistical shape modelling was carried out and outcomes were analyzed in conjunction with clinical outcomes. The 3D modelling of the valve calcification rate matched previous clinical descriptions; including the crescent shapes visible on each leaflet and the higher calcification rate of the non-coronary cusp. Higher calcification rate was found in larger valves together with a positive association between each coronary height and the calcification of their respective leaflet. Sexual dimorphism, on both shape and calcification, was recorded beyond the size differences with straighter aortas and higher calcification rate at the junction between the left and right coronary leaflets for males compared to females. Morphological differences were significantly associated (p = 0.005) with PVL assessments based on post-operative echocardiograms. Larger aortas and shorter left coronary sinus were associated with less leakage. The outcome distribution appeared to be directly affected by sexual differences and device design. Female phenotypes, smaller and more conic aortic root, were associated with worse outcome. Different patterns in calcification distribution on the leaflets were identified but the association with outcomes is not conclusive. In the future, the presented morphological characterization of patients with AS could contribute to predict post-TAVI PVL and design and test improved TAVI devices.

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