心血管磁共振成像评估主动脉狭窄与常规临床检查技术的比较

Objective: To evaluate whether direct planimetry of aortic valve area ( AVA) by cardiac magnetic resonance (CMR) imaging is a reliable tool for determining the severity of aortic stenosis compared with transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), and cardiac catheterisation. Methods: 44 symptomatic patients with severe aortic stenosis were studied. By cardiac cat heterisation AVA was calculated by the Gorlin equation. AVA was measured with CM R from steady state free precession (true fast imaging with steady state precess ion) by planimetry. AVA was also determined from TOE images by planimetry and fr om TTE images by the continuity equation. Results: Bland-Altman analysis evalua ting intraobserver and interobserver variability showed a very small bias for bo th (-0.016 and 0.019, respectively; n=20). Bias and limits of agreement between CMR and TTE were 0.05 (-0.35, 0.44) cm2 (n=37), between CMR and TOE 0.02 (-0. 39, 0.42) cm2 (n=32), and between CMR and cardiac catheterisation 0.09 (-0.30, 0.47) cm2 (n=36). The sensitivity and specificity of CMR to detect AVA ≤0.80 cm 2 measured by cardiac catheterisation was 78%and 89%, of TOE 70%and 70%, and of TTE 74%and 67%, respectively. Conclusion: CMR planimetry is highly reliabl e and reproducible. Further,CMR planimetry had the best sensitivity and specific ity of all non-invasive methods for detecting severe aortic stenosis in compari son with cardiac catheterisation. Therefore, CMR planimetry of AVA with steady s tate free precession is a new powerful diagnostic tool,particularly for patients with uncertain or discrepant findings by other modalities.

左心室射血分数正常的低压差“严重”主动脉瓣狭窄

在发达国家,主动脉瓣狭窄(AS)是最常见的心脏瓣膜病,且随着人口老龄化,其发病率也越来越高。在临床决策中,对病程及病情严重性进行准确诊断非常重要。目前的诊疗指南虽然推荐使用跨瓣膜压差、最大流速及主动脉瓣口面积来判断疾病的严重程度,但疾病严重性分级不一致仍然是临床中常见的问题。近期研究表明,伴有低流速和/或低压差的患者病情较为严重,且预后较差。目前指南所推荐的诊治模式,可能会导致对病情估计不足,延误了心脏主动脉瓣膜置换术(AVR)的进行。因此,我们需对有这一富有挑战的临床疾病的患者认真进行评估,并制订个体化临床诊疗决策。

GE 3.0血管成像与CTA在TAVR术前诊断效果的对比分析

目的 探讨GE3.0血管成像与CTA在经导管主动脉瓣置换术(TAVR)术前对主动脉瓣面积和钙化评估准确性。方法 回顾性分析在我院2015年1月~2017年12月接受TAVR治疗的AS患者80例,根据术前分别应用GE3.0血管成像与CTA检查。使用CTA及GE3.0配套电脑软件处理图像,二者配套软件可进行多重平面重建、曲线平面重建、最大密度投影及容积再现。主动脉瓣采用4分量表评估半定量评估法,程度包括其高度钙化、中度钙化、重度钙化、大量钙化。结果 GE3.0血管成像TAVR术前对主动脉瓣面积大于CTA(P<0.05),但舒张期、收缩期Bland-Altman值比较无统计学意义(P>0.05)。GE3.0血管成像在TAVR术前检查舒张期右冠状动脉窦距离小于CTA(P<0.05),距离左冠状动脉窦距离小于CTA,但差异比较无统计学意义(P>0.05)。GE3.0血管成像在TAVR术前测量患者窦管交界平面指标中的长径、周长、面积大于CTA(P<0.05),距离瓣环高度、短径、平均径、周长平均径、面积平均径大于CTA,差异比较无统计学意义(P>0.05)。GE3.0血管成像与CTA在TAVR术前检查舒张期主动脉瓣面积及距离左右冠状动脉窦距离的一致性高(ICC=0.960,0.790,0.896)。GE3.0血管成像与CTA在TAVR术前检测动脉瓣钙化程度比较差异无统计学意义(Z=-0.027,P=0.978)。结论 GE3.0血管成像与CTA在TAVR术前对主动脉瓣平均面积和钙化评估准确性一致,可作为主动脉瓣狭窄术前诊断方法。