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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Computed tomography-based coronary lumen volume to myocardial mass ratio in patients undergoing transcatheter aortic
Wenting Li1, Ruichen Ren1, Qingyuan Zhao1
1Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Insights
A lower coronary lumen volume to myocardial mass (V/M) ratio predicts major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR). This finding offers a new prognostic tool for TAVR candidates.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Clinical Prognostics
Background:
- The coronary lumen volume to myocardial mass (V/M) ratio quantifies the balance between coronary blood supply and myocardial oxygen demand.
- Assessing this ratio's prognostic value is crucial for patients undergoing transcatheter aortic valve replacement (TAVR).
Purpose of the Study:
- To evaluate the predictive capability of the V/M ratio for major adverse cardiovascular events (MACE) in patients undergoing TAVR.
- To determine if the V/M ratio can serve as an independent prognostic marker post-TAVR.
Main Methods:
- Patients undergoing TAVR were included, with V/M ratio calculated via coronary computed tomography angiography (CTA).
- Patients were dichotomized into low and high V/M ratio groups based on the median (33.31 mm³/g).
- Major adverse cardiovascular events (MACE), including all-cause mortality, stroke, and heart failure hospitalization, were tracked and analyzed using Kaplan-Meier plots and Cox regression.
Main Results:
- A lower mean V/M ratio was observed in patients who experienced MACE compared to those who did not (26.5 vs. 34.0 mm³/g, P<0.001).
- The low V/M ratio group (≤ 33.31 mm³/g) demonstrated a significantly higher risk of MACE after TAVR (Hazard Ratio: 6.14, P=0.018).
Conclusions:
- A reduced V/M ratio is an independent predictor of MACE in patients undergoing TAVR.
- The V/M ratio offers a valuable quantitative metric for risk stratification in the TAVR population.
Background:
The coronary lumen volume to myocardial mass (V/M) ratio has been suggested as a quantitative metric of potential imbalance between coronary blood supply and myocardial oxygen demand. This study was designed to assess the prognostic value of the V/M ratio for predicting major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR).
Methods:
This study enrolled patients who received a standard planning computed tomography (CT) scan before TAVR and dichotomized at the median of 33.31 mm³/g of V/M ratio into groups with low V/M ratio and high V/M ratio. The V/M ratio was calculated by coronary computed tomography angiography (CTA). The endpoint was a composite of all-cause mortality, stroke, and hospitalization for heart failure. The cumulative incidence of the MACE was compared using Kaplan-Meyer plots and uni- and multivariate Cox proportional hazards regression analysis.
Results:
In total, 139 patients were enrolled in this study finally (mean age 71.7 ± 6.7 years, 41.7% female). The mean V/M ratio was considerably lower in patients with MACE than in those without MACE (26.5 ± 4.9mm3/g vs. 34.0 ± 3.8mm3/g, P<0.001). Multivariate Cox proportional hazards regression showed that the low V/M ratio group (≤ 33.31 mm³/g) had a higher risk of MACE after TAVR (HR: 6.14, 95%CI: 1.37-27.54; P = 0.018).
Conclusions:
The lower V/M ratio could serve as an independent predictor of MACE in patients undergoing TAVR.
Clinical Trial Number:
Not applicable.
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