使用心声学和心脏CTCT对高梯度或低梯度大动脉狭窄的多模式评估
Irfan Zeb1, Raafay Uqaily1, Karthik Gonuguntla1
1Heart & Vascular Institute at West Virginia University, Morgantown, WV, USA.
Journal of cardiovascular computed tomography
|October 8, 2023
概括
来自CT-LVOT测量<1.2厘米2的大动脉面积 (AVA) 是严重大动脉狭窄 (AS) 的可靠指标. 然而,高甲状腺 (AVC) 的大LVOT甚至在AVA>1.2cm2的情况下也可以表明严重的AS,这凸显了索引AVA和AVC的重要性.
科学领域:
- 心血管成像 - 心血管成像
- 心脏外科手术 心脏外科手术
- 放射学 放射学是一门学科.
背景情况:
- 大动脉狭窄 (AS) 诊断依赖于大动脉膜面积 (AVA) 测量.
- 使用左心室外流通道 (LVOT) 区域 (AVACT-LVOT) 的计算机断层扫描 (CT) 衍生的AVA (AVACT-LVOT) <1.2厘米2显示与回声心脏学AVA <1.0厘米2的可比性严重的AS.
- 在AS评估中,CT衍生的LVOT用心声谱衍生的LVOT替换的诊断影响需要评估.
研究的目的:
- 评估AS诊断如何受到使用心声回声学衍生的LVOT而不是CT衍生的LVOT的影响.
- 评估AVACT-LVOT值的诊断性能,以识别严重的AS.
- 调查大动脉 (AVC) 和LVOT维度在AS严重性评估中的作用.
主要方法:
- 对367名接受心脏CTA和心声回声扫描的患者进行了回顾性分析.
- AVACT-LVOT使用CT-LVOT区域和心声回声数据进行计算.
- 患者被分为三个AVACT-LVOT组:<1.0厘米2,1.0-1.2厘米和>1.2厘米2.
- 结果定义为所有原因死亡率和/或门干预的复合.
主要成果:
- 在高梯度AS (HG-AS) 中,在AVACT-LVOT类别中一致确定了严重的AS.
- 在低梯度AS (LG-AS) 患者中,AVACT-LVOT ≤1.2 cm2,57%的患者患有低流量AS,63%的患者符合AVC的严重AS标准.
- 患者AVACT-LVOT>>1.2厘米2和升高的AVC表现出严重AS的特征,包括大身体表面积和索引的AVA/AVC.
- 使用CT-LVOT的冲击体积指数将70%的低流量LG-AS重新归类为正常流量LG-AS.
- 综合结局在AVACT-LVOT≤1.2cm2 (p<0.01) 的患者中较高,但在AVA回声<1.0cm2的患者中没有优异的重新分类改善.
结论:
- AVACT-LVOT ≤1.2厘米2作为诊断严重AS的合理CT标准.
- 较大的LVOT与升高的AVC相结合,可以表明严重的AS表型,即使AVACT-LVOT超过1.2厘米2.
- 索引的AVA和AVC对于在特定患者亚组中表征严重的AS至关重要.
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