瓣环与左室流出道椭圆率比值及瓣环离心指数对TAVR患者远期预后的预测价值

Predictive value of valvular annulus to left ventricular outflow tract ellipticity ratio and valvular annulus centrifugal index to long-term prognosis in patients undergone transcatheter aortic valve replacement

目的分析探讨主动脉根部因素瓣环与左室流出道(LVOT)椭圆率比值、瓣环离心指数对经导管主动脉瓣置换术(TAVR)患者远期预后的预测价值。方法回顾性分析2016年1月至2022年5月于新疆医科大学第一附属医院心脏中心行TAVR治疗的主动脉瓣狭窄(AVS)患者86例,根据患者瓣环离心指数与瓣环形态的关系,分为离心指数<0.1组(n=62)及离心指数≥0.1组(n=24),同时根据患者瓣环与LVOT形态相似程度优劣将患者分为椭圆率比值>1组(n=23)及椭圆率比值≤1组(n=63)。分别比较瓣环离心指数、瓣环与LVOT椭圆率比值对患者远期预后的影响,并用Cox回归分析影响TAVR患者预后的预测因素。使用ROC曲线、校准曲线、DCA曲线分析预测能力的效能、精准度、临床效用。结果多因素Cox回归结果:瓣环离心指数<0.1(HR:0.13,95%CI:0.02~0.86,P=0.034)、瓣环与LVOT椭圆率比值>1(HR:7.98,95%CI:1.85~34.39,P=0.005)、无冠状窦下瓣膜植入深度>5 mm(HR:5.29,95%CI:1.51~18.55,P=0.009)是TAVR术后远期(1年)永久起搏器植入(PPI)的独立预测因素。ROC曲线、校准曲线、DCA曲线分析结果分别提示:瓣环与LVOT椭圆率比值、瓣环离心指数联合瓣膜植入深度预测远期PPI的效能较好(AUC:0.919,95%CI:0.822~1.000,P<0.001),精准度较高(C指数为0.894,95%CI:0.809~0.979,P<0.001),且具有一定临床效用。结论作为AVS患者主动脉根部差异的评估方式,瓣环与LVOT椭圆率比值、瓣环离心指数对TAVR患者远期预后具有一定预测价值,且联合已知预测因素瓣膜植入深度预测远期PPI的效能较好、精准度较高,具有一定临床效用。

Objective To analyze the predictive value of aortic root factors[ratio of valvular annulus to ellipticity of left ventricular outflow tract(VA/LVOT ellipticity ratio),valvular annulus centrifugal index(VACI)]to long-term prognosis in patients undergone transcatheter aortic valve replacement(TAVR).Methods The patients with aortic valve stenosis(AVS)undergone TAVR(n=86)were retrospectively analyzed in Heart Center in the First Affiliated Hospital of Xinjiang Medical University from Jan.2016 to May 2022.The patients were divided,according to relationship between VACI and VA morphology,into VACI<0.1 group(n=62)and VACI≥0.1 group(n=24).Meanwhile the patients were divided,according to the similarity degree of VA and LVOT morphology,into VA/LVOT ellipticity ratio>1 group(n=23)and VA/LVOT ellipticity ratio≤1 group(n=63).The influence of VACI and VA/LVOT ellipticity ratio on long-term prognosis.The predictive factors for prognosis in patients undergone TAVR were analyzed by using Cox regression analysis.The efficacy,accuracy and clinical utility of the predictive capabilities were analyzed by using ROC curve,calibration curves and DCA curve.Results The Results of multifactor Cox regression analysis showed that VACI<0.1(HR:0.13,95%CI:0.02~0.86,P=0.034),VA/LVOT ellipticity ratio>1(HR:7.98,95%CI:1.85~34.39,P=0.005)and non-coronary subsinus valve implantation depth>5 mm(HR:5.29,95%CI:1.51~18.55,P=0.009)were independent predictive factors for long-term(1 y)permanent pacemaker implantation(PPI)after TAVR.The Results of ROC curve,calibration curves and DCA curve analyses showed that VA/LVOT ellipticity ratio and VACI combined with valve implantation depth had a higher efficacy in predicting long-term PPI(AUC:0.919,95%CI:0.822~1.000,P<0.001)and higher accuracy(C index=0.894,95%CI:0.809~0.979,P<0.001),and had some clinical effectiveness.Conclusion As a method for reviewing aortic root differences in AVS patients,VA/LVOT ellipticity ratio and VACI have certain predictive value to long-term prognosis in patients undergone TAVR,and they combined with valve implantation depth have higher efficacy and accuracy for predicting long-term PPI with some clinical effectiveness.