医学
狼牙棒
危险系数
心肌梗塞
心脏病学
内科学
部分流量储备
阀门更换
不稳定型心绞痛
回顾性队列研究
狭窄
主动脉瓣置换术
主动脉瓣狭窄
冠状动脉疾病
主动脉瓣
放射科
置信区间
冠状动脉造影
经皮冠状动脉介入治疗
作者
Gilberto J. Aquino,Andres F. Abadia,U. Joseph Schoepf,Tilman Emrich,Basel Yacoub,Ismail Kabakus,Alexis Violette,Courtney Wiley,Andreina Moreno,Pooyan Sahbaee,Chris Schwemmer,Richard R. Bayer,Akos Varga-Szemes,Daniel H. Steinberg,Nicholas Amoroso,Madison Kocher,Jeffrey Waltz,Thomas J. Ward,Jeremy R. Burt
出处
期刊:Radiology
[Radiological Society of North America]
日期:2022-01-01
卷期号:302 (1): 50-58
被引量:3
标识
DOI:10.1148/radiol.2021210160
摘要
Background The role of CT angiography-derived fractional flow reserve (CT-FFR) in pre-transcatheter aortic valve replacement (TAVR) assessment is uncertain. Purpose To evaluate the predictive value of on-site machine learning-based CT-FFR for adverse clinical outcomes in candidates for TAVR. Materials and Methods This observational retrospective study included patients with severe aortic stenosis referred to TAVR after coronary CT angiography (CCTA) between September 2014 and December 2019. Clinical end points comprised major adverse cardiac events (MACE) (nonfatal myocardial infarction, unstable angina, cardiac death, or heart failure admission) and all-cause mortality. CT-FFR was obtained semiautomatically using an on-site machine learning algorithm. The ability of CT-FFR (abnormal if ≤0.75) to predict outcomes and improve the predictive value of the current noninvasive work-up was assessed. Survival analysis was performed, and the C-index was used to assess the performance of each predictive model. To compare nested models, the likelihood ratio χ2 test was performed. Results A total of 196 patients (mean age ± standard deviation, 75 years ± 11; 110 women [56%]) were included; the median time of follow-up was 18 months. MACE occurred in 16% (31 of 196 patients) and all-cause mortality in 19% (38 of 196 patients). Univariable analysis revealed CT-FFR was predictive of MACE (hazard ratio [HR], 4.1; 95% CI: 1.6, 10.8; P = .01) but not all-cause mortality (HR, 1.2; 95% CI: 0.6, 2.2; P = .63). CT-FFR was independently associated with MACE (HR, 4.0; 95% CI: 1.5, 10.5; P = .01) when adjusting for potential confounders. Adding CT-FFR as a predictor to models that include CCTA and clinical data improved their predictive value for MACE (P = .002) but not all-cause mortality (P = .67), and it showed good discriminative ability for MACE (C-index, 0.71). Conclusion CT angiography-derived fractional flow reserve was associated with major adverse cardiac events in candidates for transcatheter aortic valve replacement and improved the predictive value of coronary CT angiography assessment. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Choe in this issue.
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