摘要
目的观察数字减影血管造影(DSA)彩色编码成像用于评估经导管植入主动脉瓣(TAVI)后主动脉瓣反流(AR)的价值。方法回顾性分析103例接受TAVI的主动脉瓣膜病变患者,于TAVI后即刻利用彩色编码成像编码DSA,计算反流分数、评估AR严重程度,分析所获结果与超声心动图评估结果的一致性;根据左心室流出道面积与主动脉根部面积比值确定AR最佳截断值并进行分组,比较组间TAVI后3~6个月与治疗前超声心动图常规心脏参数、血流动力学参数及并发症。结果103例中,1例于治疗后30天内死于脑卒中。对其余102例,DSA彩色编码成像与超声心动图评估TAVI后AR的一致性较好(Kappa=0.626)。以左心室流出道面积与主动脉根部面积比值=0.14为最佳截断值划分≥0.14组(n=23,轻度及以上反流)与<0.14组(n=79,无/微量反流);相比治疗前,≥0.14组TAVI后最大跨瓣流速、平均跨瓣压差、左心室射血分数(LVEF)、室间隔厚度、左心室后壁厚度及左心室收缩末期容量均改善(P均<0.05);<0.14组TAVI后最大跨瓣流速、平均跨瓣压差、LVEF、左心室舒张末期及收缩末期内径、左心室舒张末期及收缩末期容积均获改善(P均<0.05);≥0.14组TAVI后房室传导阻滞及植入永久起搏器发生率均高于<0.14组(P均<0.05)。结论DSA彩色编码成像可用于评估TAVI后AR并有利于AR风险分层。
Objective To observe the value of color-coded digital subtraction angiography(DSA)imaging for evaluating aortic regurgitation(AR)after transcatheter aortic valve implantation(TAVI).Methods Totally 103 patients with aortic valve diseases who underwent TAVI were retrospectively enrolled.Color-coded imaging was performed to encode DSA immediately after TAVI for calculating regurgitation fraction and assessing the severity of AR,and its consistency with echocardiographic results was analyzed.The patients were divided into 2 groups based on the optimal cutoff value of ratio of left ventricular outflow tract area to aortic root area,and conventional echocardiographic cardiac parameters and hemodynamic parameters,as well as complications 3—6 months after TAVI were compared between groups.Results One patinet died of stroke within 30 days after TAVI.For 102 cases,color-coded DSA imaging demonstrated good consistency with echocardiography for assessing AR after TAVI(Kappa=0.626).Taken 0.14 as the cutoff value of the ratio of left ventricular outflow tract area to aortic root area,the patients were divided into≥0.14 group(n=23,mild or worse regurgitation)and<0.14 group(n=79,no/minimal regurgitation).Compared with baseline data,≥0.14 group demonstrated improvements in peak transvalvular flow velocity,mean transvalvular pressure gradient,left ventricular ejection fraction(LVEF),interventricular septal thickness,left ventricular posterior wall thickness and end-systolic left ventricular volume after TAVI(all P<0.05),while in<0.14 group,significant improvements of peak transvalvular flow velocity,mean transvalvular pressure gradient,LVEF,left ventricular end-diastolic and end-systolic diameters,left ventricular end-diastolic and end-systolic volumes were observed(all P<0.05).The incidences of atrioventricular block and permanent pacemaker implantation after TAVI in≥0.14 group were higher than those in<0.14 group(both P<0.05).Conclusion Color-coded DSA imaging was feasible for evaluating AR after TAVI,hence was conducive to risk stratification.
作者
简能日
夏春潮
周轩
李真林
JIAN Nengri;XIA Chunchao;ZHOU Xuan;LI Zhenlin(Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中国医学影像技术》
北大核心
2026年第2期290-294,共5页
Chinese Journal of Medical Imaging Technology
