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Radiology:在看主动脉瓣钙化时,别忘了再看看它!

2021-11-20 shaosai MedSci原创

主动脉瓣狭窄是一种由主动脉瓣硬化引起的渐进性疾病,其特点是主动脉瓣小叶的钙化和增厚,从而导致最终的瓣口梗阻。主动脉瓣钙化(AVC)及其进展是主动脉瓣狭窄的一个重要特征,其与病情的恶化直接相关。

主动脉瓣狭窄是一种由主动脉瓣硬化引起的渐进性疾病,其特点是主动脉瓣小叶的钙化和增厚,从而导致最终的瓣口梗阻。主动脉瓣钙化(AVC)及其进展是主动脉瓣狭窄的一个重要特征,病情的恶化直接相关

多普勒超声心动图是目前诊断和划分主动脉瓣狭窄严重程度的首选影像学手段,但仅使用静息超声心动图时,约有三分之一患者主动脉瓣狭窄的严重程度评估存在不一致。最近的指南将AVC评分纳入主动脉瓣狭窄严重程度的评估中,对超声心动图评估不一致的患者采用特定性别的阈值来明确主动脉瓣狭窄的严重程度

冠状动脉粥样硬化与主动脉瓣狭窄有许多共同的临床危险因素,而冠状动脉疾病(CAD)是主动脉瓣狭窄患者的一个负预测指标。因此,在计划手术或经导管主动脉瓣置换术时,建议使用有创冠状动脉造影或冠状动脉CT血管造影冠状动脉进行评估

众所周知冠状动脉钙化是公认的CAD影像学评估指标然而,关于评估AVC和冠状动脉钙化之间相关性的研究结果差异较大。同样地,AVC的年度进展是否与冠状动脉粥样硬化的进展有关仍存在争议。

近日,发表在Radiology杂志的一项研究探讨了AVC的进展与斑块体积的总成分和个别成分进展的关系,有助于提高对每种疾病机制的理解,并有利于临床设计更有效的随访和治疗策略

对每隔2年或更长时间接受连续冠状动脉CT血管造影的连续参与者进行了前瞻性的分析。对AVC以及基线和后续血管造影时的总体积和斑块体积组成进行了定量分析。斑块体积通过使用研究人群的平均总分析血管长度进行标准化。

594名参与者(平均年龄±标准差,62岁±10岁;330名男性)被纳入评估(基线和后续血管造影之间的平均间隔,3.9年±1.5年)。基线时,AVC评分为31 Agatston单位±117,基线时正常化的总斑块体积为122 mm3±219。调整了年龄、性别、临床危险因素和药物使用后,AVC与基线时的总斑块体积(标准化β=0.24;95% CI:0.16,0.32;P < .001)以及钙化(β=0.26;95% CI:0.18,0.34;P < .001)和非钙化(β=0.17;95% CI:0.08,0.25;P < .001)斑块体积独立AVC的进展与总斑块体积的进展相关(β = 0.13; 95% CI: 0.03, 0.22; P = .01)钙化斑块体积(β = 0.24; 95% CI: 0.14, 0.34; P < .001)而非非钙化斑块体积(β = -0.06; 95% CI: -0.14, 0.03; P = .17)的影响

 

 主动脉瓣钙化(AVC)和冠状动脉粥样硬化在冠状动脉CTA图表现为进展的代表示例。A,78岁男性,患有稳定胸痛,正在接受抗血小板和他汀类药物的治疗。随访时AVC从1857个单位明显增加到3124个单位,而且该参与者出现了严重的主动脉狭窄。斑块总体积(PV)也增加了,这完全是由钙化斑块体积的增加引起的。非钙化斑块体积减少。B,72岁女性,患有非典型胸痛。5年后,AVC从43个单位增加到187个Agatston单位。斑块总体积从127mm3增加到476mm3,这是由钙化和非钙化斑块体积的增加引起的。AV = 主动脉瓣,LAD = 左前降支动脉,LCX = 左回旋动脉,RCA = 右冠状动脉。

本研究表明,当对怀疑有冠状动脉疾病(CAD)且基线时没有或只有极少的主动脉瓣狭窄的参与者进行主动脉瓣钙化(AVC)评估时,其疾病的进展与冠状动脉粥样硬化的总负荷以及钙化和非钙化斑块体积有显著关系。尽管AVC的进展与总斑块体积的进展有关联,但它是由钙化斑块体积和AVC之间的关联驱动的。非钙化斑块体积的发展与AVC之间没有相关性本研究结果为临床早期诊断主动脉狭窄患者并制定个性化治疗方案提供了参考依据

原文出处

Sang-Eun Lee,Ji Min Sung,Daniele Andreini,er al.Association between Aortic Valve Calcification Progression and Coronary Atherosclerotic Plaque Volume Progression in the PARADIGM Registry.DOI:10.1148/radiol.2021202630

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    2022-03-04 ms8000001376185344

    学到了

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    2021-11-20 ms6000000656440728

    主动脉瓣狭窄越来越常见,如何早期干预是值得思考的

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在多血管CAD患者中,没有发现证据表明FFR指导的治疗策略在1年的随访中能降低缺血性心血管事件或死亡的风险。

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