■通过多普勒超声心动图(AVCdEcho)测量的主动脉瓣钙化(AVC)对主动脉瓣环(AA)面积的指数化为主动脉瓣狭窄(AS)患者提供了强大的预后信息。然而,从未评估通过多探测器计算机断层扫描(AVCdCT)测量的AA指数化。这项研究的目的是比较AVC,AVCdCT,和AVCdEcho关于AS患者的血流动力学相关性和临床结局。
■来自889名患者的数据,主要是白色,回顾性分析钙化性AS患者在同一治疗期间接受了多普勒超声心动图和多排CT检查.通过多普勒超声心动图和多探测器计算机断层扫描测量AA。分别使用男性和女性的受试者工作特征曲线分析来建立AVCdCT严重程度阈值。主要终点是全因死亡率的发生。
■使用AVCdCT(r=0.68,P<0.001和r=0.66,P<0.001)的梯度/速度与AVCd之间的相关性强于AVC(r=0.61,P<0.001和r=0.60,P<0.001)或AVCdEcho(r=0.61,P<0.001和r=0.59,P<0.001)。用于识别严重AS的AVCdCT阈值为女性334Agatston单位(AU)/cm2,男性467AU/cm2。在6.62(6.19-9.69)年的中位随访时间中,在多变量分析中,AVCdCT比率优于AVC比率和AVCdEcho比率来预测全因死亡率(危险比[HR],1.59[95%CI,1.26-2.00];与HR相比,P<0.001,1.53[95%CI,1.11-1.65];P=0.003与HR,1.27[95%CI,1.11-1.46];P<0.001;全似然检验P≤0.004)。在多变量分析中,AVCdCT比率优于AVC比率和AVCdEcho比率来预测药物治疗下的生存率(HR,1.80[95%CI,1.27-1.58];与HR相比,P<0.001,1.55[95%CI,1.13-2.10];P=0.007;HR,1.28[95%CI,1.03-1.57];P=0.01;全似然检验P<0.03)。AVCdCT比率可预测所有AS患者亚组的死亡率。
■AVCdCT在评估AS严重程度和预测全因死亡率方面似乎与AVC和AVCdEcho相当或优于AVC和AVCdEcho。因此,对于有或没有低流量状态的超声心动图评估结果不确定的患者,该方法应用于评估AS严重程度.女性的AVCdCT阈值为300AU/cm2,男性为500AU/cm2似乎适合识别严重的AS。需要进一步的研究来验证这些阈值,尤其是在不同的人群中。
UNASSIGNED: Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCdEcho) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCdCT) has never been evaluated. The aim of this study was to compare AVC, AVCdCT, and AVCdEcho with regard to hemodynamic correlations and clinical outcomes in patients with AS.
UNASSIGNED: Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCdCT severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.
UNASSIGNED: Correlations between gradient/velocity and AVCd were stronger (both P≤0.005) using AVCdCT (r=0.68, P<0.001 and r=0.66, P<0.001) than AVC (r=0.61, P<0.001 and r=0.60, P<0.001) or AVCdEcho (r=0.61, P<0.001 and r=0.59, P<0.001). AVCdCT thresholds for the identification of severe AS were 334 Agatston units (AU)/cm2 for women and 467 AU/cm2 for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCdCT ratio was superior to AVC ratio and AVCdEcho ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; P<0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; P=0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; P<0.001; all likelihood test P≤0.004). AVCdCT ratio was superior to AVC ratio and AVCdEcho ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; P<0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; P=0.007; HR, 1.28 [95% CI, 1.03-1.57]; P=0.01; all likelihood test P<0.03). AVCdCT ratio predicts mortality in all subgroups of patients with AS.
UNASSIGNED: AVCdCT appears to be equivalent or superior to AVC and AVCdEcho to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCdCT thresholds of 300 AU/cm2 for women and 500 AU/cm2 for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.