目的:本研究旨在比较缩窄修复患者和对照组的主动脉形态,并确定缩窄患者高血压和心血管事件(CVEs)的主动脉形态危险因素。
方法:纳入计算机断层扫描血管造影(CTA)或磁共振血管造影(MRA)修复的缩窄患者,随访并与性别匹配和年龄匹配的对照进行比较。使用患者CTA或MRA重建三维主动脉形状,或对照中的四维流心血管磁共振,使用统计形状建模计算和可视化高级几何特征。在患者中,我们检查了几何特征与(1)基线高血压的关系,使用多变量逻辑回归;和(2)心血管事件(CVE,复合主动脉并发症,冠状动脉疾病,室性心律失常,心力衰竭住院,中风,短暂性脑缺血发作和心血管死亡),使用多变量Cox回归。最小绝对收缩和选择算子(LASSO)方法选择了信息量最大的多变量模型。
结果:纳入65例修复缩窄患者(23岁(IQR19-38)),其中44例(68%)患者在基线时为高血压.经过8.7年的中位随访(IQR4.8-15.4),20例患者发生了27例CVE。与对照组相比,患者的主动脉弓尺寸较小(直径p<0.001,壁表面积p=0.026,体积p=0.007)。患者有更多的主动脉弓扭转(p<0.001)和更高的曲率(p<0.001)。没有几何特征与高血压相关。LASSO选择左心室质量,男性,多变量模型的弯曲度和年龄。左心室质量(p=0.014)与CVE独立相关,主动脉弯曲呈显著性趋势(p=0.070)。
结论:与对照组相比,缩窄修复患者的主动脉弓更小,主动脉弯曲更多。除了左心室质量指数,几何特征在缩窄患者的长期风险评估中可能很重要.
OBJECTIVE: This study aims to compare aortic morphology between repaired coarctation patients and controls, and to identify aortic morphological risk factors for hypertension and cardiovascular events (CVEs) in coarctation patients.
METHODS: Repaired coarctation patients with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were included, followed-up and compared with sex-matched and age-matched controls. Three-dimensional aortic shape was reconstructed using patients\' CTA or MRA, or four-dimensional flow cardiovascular magnetic resonance in controls, and advanced geometrical characteristics were calculated and visualised using statistical shape modelling. In patients, we examined the association of geometrical characteristics with (1) baseline hypertension, using multivariable logistic regression; and (2) cardiovascular events (CVE, composite of aortic complications, coronary artery disease, ventricular arrhythmias, heart failure hospitalisation, stroke, transient ischaemic attacks and cardiovascular death), using multivariable Cox regression. The least absolute shrinkage and selection operator (LASSO) method selected the most informative multivariable model.
RESULTS: Sixty-five repaired coarctation patients (23 years (IQR 19-38)) were included, of which 44 (68%) patients were hypertensive at baseline. After a median follow-up of 8.7 years (IQR 4.8-15.4), 27 CVEs occurred in 20 patients. Aortic arch dimensions were smaller in patients compared with controls (diameter p<0.001, wall surface area p=0.026, volume p=0.007). Patients had more aortic arch torsion (p<0.001) and a higher curvature (p<0.001). No geometrical characteristics were associated with hypertension. LASSO selected left ventricular mass, male sex, tortuosity and age for the multivariable model. Left ventricular mass (p=0.014) was independently associated with CVE, and aortic tortuosity showed a trend towards significance (p=0.070).
CONCLUSIONS: Repaired coarctation patients have a smaller aortic arch and a more tortuous course of the aorta compared with controls. Besides left ventricular mass index, geometrical features might be of importance in long-term risk assessment in coarctation patients.