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索引大动脉膜区域使用多模式成像来评估双大动脉狭窄症的严重程度

Nobuichiro Yagi¹, Hiroko Hasegawa¹, Ken Kuwajima¹

¹Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA.

International journal of cardiology

|August 4, 2024

概括

影像成像方式的选择显著影响到对双主动脉 (BAV) 患者大动脉狭窄严重程度的评估. 与其他方法相比,三维透食管心声学 (3D TEE) 在分级大动脉狭窄方面提供了更好的准确性.

科学领域:

心脏病学心脏病学
医疗成像医学成像
心声回声图 (Echocardiography) 是一种心声回声图.

背景情况:

在双主动脉 (BAV) 患者中评估大动脉狭窄症 (AS) 严重程度,由于大动脉面积索引 (iAVA) 和导管导管衍生平均横向性压力梯度 (mPGcath) 之间潜在的不一致性,因此存在挑战.
不同的成像方式对这种不一致性的影响尚未得到充分证实.

研究的目的:

用四种不同的方法在患有BAV和三大动脉 (TAV) 的患者中比较iAVA测量.
评估iAVA和mPGcath在各种成像技术之间的一致性,使用导管作为参考标准.

主要方法:

在2019-2022年间进行AS评估的564名患者 (64名BAV,500名TAV) 的回顾性分析.
采用了2D跨胸腔心声学 (TTE),3D食道间心声学 (TEE),多探测器计算机断层扫描 (MDCT) 和心脏导管.
通过连续性方程 (CE) 测量iAVA,使用2D TTE,3D TEE,MDCT以及平面3D TEE的LVOT面积.

主要成果:

2D TTE衍生的iAVA (iAVA_CE(2DTTE)) 在BAV (23.4%) 和TAV (28.1%) 患者中都高估了AS严重程度.
由MDCT衍生的iAVA (iAVA_CE(MDCT)) 在BAV (29.3%) 和TAV (16.7%) 患者中低估了AS严重程度.
3D TEE方法 (iAVA_CE(3DTEE)和iAVA_Plani(3DTEE)) 降低了AS分级不一致性,显示与mPGcath的中等相关性 (r ≈ -0.63到 -0.68).

结论:

在AS严重程度分级中的iAVA和mPGcath之间的不一致性与成像方式和测量方法有很大的不同.
三维透食管心声学 (3D TEE) 方法,特别是iAVA_CE(3DTEE),证明了在BAV和TAV患者中协调不一致的AS分级的价值.
iAVA_CE(3DTEE)与BAV和TAV群体中AS严重程度的当前指南截止值保持一致.

关键词:

大动脉狭窄症大动脉狭窄症双主动脉门的双主动脉门混合成像技术混合成像技术三维跨食道心电回声学是三维的.

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