评估常规术前CT血管造影在低温球囊肺静脉隔离中的价值:一项前瞻性、倾向评分匹配的研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Krisztian Istvan Kassa , Csenge Jurenka , Zoltan Som , Csaba Foldesi , Attila Kardos
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To minimize selection bias, 1:1 propensity score matching (PSM) was applied based on baseline characteristics, including age, sex, left atrial diameter, BMI, and AF type. Coronary artery disease (CAD) was assessed in the CTA group, and three-dimensional left atrial reconstruction images assisted the operator during the procedure.</div></div><div><h3>Results</h3><div>After PSM, 320 patients (160 per group) were included in the final analysis. Procedural time was comparable between the CTA and control groups (52 ± 13 min vs. 51 ± 15 min, p = 0.36), as was left atrial dwell time (39.9 ± 11 min vs. 40.5 ± 13 min, p = 0.63). Acute pulmonary vein isolation rates (96 % vs. 92 %, p = 0.23) and 12-month arrhythmia-free survival (CTA: 75 % vs. control: 75.6 %, p = 0.90) did not significantly differ. 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引用次数: 0

摘要

本研究旨在评估常规术前左心房和冠状动脉ct血管造影(CTA)对低温球囊肺静脉隔离术(PVI)患者手术策略和临床结果的影响。方法在这项前瞻性、倾向评分匹配的研究中,我们分析了2019年1月至2023年3月期间在我们机构接受低温球囊PVI的患者。患者被分配到CTA组,在术前进行CTA,或对照组,在PVI仅由透视引导。为了尽量减少选择偏差,根据基线特征(包括年龄、性别、左心房内径、BMI和房颤类型)应用1:1倾向评分匹配(PSM)。在CTA组评估冠状动脉疾病(CAD),三维左心房重建图像在手术过程中协助操作员。结果经PSM治疗后,320例(每组160例)纳入最终分析。CTA组和对照组的手术时间(52±13分钟比51±15分钟,p = 0.36)和左房停留时间(39.9±11分钟比40.5±13分钟,p = 0.63)相当。急性肺静脉隔离率(96%对92%,p = 0.23)和12个月无心律失常生存率(CTA: 75%对对照组:75.6%,p = 0.90)无显著差异。然而,CTA组中有84例(52.5%)患者未确诊CAD,导致23例(27.4%)患者转诊进行有创冠状动脉造影。结论常规术前CTA对低温球囊PVI的手术效率和临床结果无显著影响。然而,先前未确诊的CAD的高患病率强调了冠状动脉评估在这一人群中的潜在价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Assessing the value of routine preprocedural CT angiography in cryoballoon pulmonary vein isolation: a prospective, propensity score–matched study

Assessing the value of routine preprocedural CT angiography in cryoballoon pulmonary vein isolation: a prospective, propensity score–matched study

Background

We aimed to evaluate the impact of routine preprocedural left atrial and coronary computed tomography angiography (CTA) on procedural strategies and clinical outcomes in patients undergoing cryoballoon pulmonary vein isolation (PVI).

Methods

In this prospective, propensity score–matched study, we analyzed patients who underwent cryoballoon PVI at our institution between January 2019 and March 2023. Patients were assigned to either a CTA group, where preprocedural CTA was performed, or a control group, where PVI was guided by fluoroscopy alone. To minimize selection bias, 1:1 propensity score matching (PSM) was applied based on baseline characteristics, including age, sex, left atrial diameter, BMI, and AF type. Coronary artery disease (CAD) was assessed in the CTA group, and three-dimensional left atrial reconstruction images assisted the operator during the procedure.

Results

After PSM, 320 patients (160 per group) were included in the final analysis. Procedural time was comparable between the CTA and control groups (52 ± 13 min vs. 51 ± 15 min, p = 0.36), as was left atrial dwell time (39.9 ± 11 min vs. 40.5 ± 13 min, p = 0.63). Acute pulmonary vein isolation rates (96 % vs. 92 %, p = 0.23) and 12-month arrhythmia-free survival (CTA: 75 % vs. control: 75.6 %, p = 0.90) did not significantly differ. However, previously undiagnosed CAD was identified in 84 patients (52.5 %) in the CTA group, leading to 23 (27.4 %) referrals for invasive coronary angiography.

Conclusions

Routine preprocedural CTA did not significantly impact procedural efficiency or clinical outcomes in cryoballoon PVI. However, the high prevalence of previously undiagnosed CAD underscores the potential value of coronary assessment in this population.
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来源期刊
IJC Heart and Vasculature
IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
10.30%
发文量
216
审稿时长
56 days
期刊介绍: IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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