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心脏磁共振成像与计算机断层扫描以指导透气管大动脉置换:一个随机的,开放的,非劣势试验

Martin Reindl¹, Ivan Lechner¹, Magdalena Holzknecht¹

¹University Clinic of Internal Medicine III, Cardiology and Angiology (M.R., I.L., M.H., C.T., P.F., F.O., S.v.d.E., C.B., G.K., A.B., B.M., S.J.R.), Medical University of Innsbruck, Austria.

|August 27, 2023

概括

心脏磁共振成像 (CMR) 引导的横导管大动脉置换 (TAVR) 与计算机断层扫描 (CT) 引导的TAVR一样有效. 这项研究表明CMR是TAVR规划的可行替代方案,特别是对于患有脏疾病的患者.

科学领域:

心脏病学
医学成像
干预心脏病学

背景情况:

计算机断层扫描 (CT) 是指导过导管大动脉置换 (TAVR) 的标准.
在CT中使用的有的对比剂对患有慢性病 (CKD) 的TAVR候选人构成风险.
心脏磁共振成像 (CMR) 提供了无对比的替代方案,但缺乏比较数据.

研究的目的:

为了比较CMR引导和CT引导TAVR的有效性.
为了确定CMR是否不低于CT用于TAVR规划.
评估CMR作为TAVR程序的替代成像方式.

主要方法:

进行了一项前性,随机,开放的非劣势性试验.
接受TAVR评估的患者被随机 (1:1) 分给CMR或CT指导.
主要结局是Valve学术研究联盟2定义的离院植入成功.

主要成果:

通过CMR指导的TAVR显示与CT指导的TAVR相比没有劣势.
在CMR组的93. 5%和CT组的90. 7% (改变治疗意图) 实现了植入成功.
植入成功的组间差异达到非劣势差 (2. 8% [90% CI, - 2. 7% 至 8. 2%]).

结论:

在装置植入成功方面,CMR指导的TAVR与CT指导的TAVR不相差.
CMR是TAVR规划的安全有效替代方案.
这支持在TAVR候选人中使用CMR,特别是那些患有CKD的人.

关键词:

计算机断层扫描磁共振成像通过导管更换大动脉

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