自动软件在经导管主动脉瓣置换术前评估中的价值:与手动测量的对比研究

doi:10.6040/j.issn.1671-7554.0.2024.0710

摘要/Abstract

摘要： 目的评价自动分析软件ValvePlus在经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)术前评估的价值,探讨其与手动测量的相关性、一致性,分析瓣膜钙化程度对测量结果的影响,并比较测量耗时及所推荐瓣膜型号的准确性。方法回顾性搜集138例行主动脉CTA检查的主动脉瓣狭窄患者的临床及影像资料,分别采用手动及自动软件测量主动脉瓣环面积、周长、最大直径及最小直径;左、右冠状动脉开口高度;升主动脉、左室流出道、窦管交界处的最大直径、最小直径;三个主动脉窦到对侧结合部的距离等参数,记录测量耗时,使用皮尔逊相关系数(r)及组内相关系数(intraclass correlation coefficient, ICC)比较两种方法的相关性及一致性,并绘制Bland-Altman图进一步分析差异,根据瓣膜钙化程度分组,比较不同亚组的相关性及一致性,使用配对样本t检验比较二者测量时间,采用Kappa检验评价两种方法推荐瓣膜型号及与最终实际选择瓣膜型号的一致性。结果 138例患者中男93例,平均64岁,所有患者主动脉瓣均为三叶瓣,80.4%的患者合并轻度及以上主动脉瓣返流。手动测量与自动测量具有较好的相关性及一致性,r值为0.844~0.990,ICC为0.841~0.988,其中瓣环面积的r值及ICC最高,分别为0.990、0.988。96例患者瓣膜中重度钙化,不同瓣膜钙化亚组,两种方法均具有较高的相关性及一致性,r及ICC均>0.8。自动测量显著缩短了测量时间［3 min(29±24)s vs. 8 min(14±36)s, P<0.001］。基于自动测量的瓣环面积、周长、平均直径推荐瓣膜型号与实际应用瓣膜型号的Kappa分别为0.886、0.765、0.761。结论 ValvePlus可以提供可靠的TAVR术前主动脉根部解剖参数信息,在不同钙化亚组与手动测量均具有较高的相关性及一致性,并且显著减少测量所需时间,基于自动测量所推荐瓣膜型号较准确,有助于辅助TAVR团队进行精准评估,指导瓣膜型号的选择。

关键词: 经导管主动脉瓣置换术, 主动脉瓣狭窄, 主动脉瓣环, CT血管造影

Abstract: Objective To evaluate the value of automatic analysis software(ValvePlus)before transcatheter aortic valve replacement(TAVR), discuss the correlation and consistency between ValvePlus and manual measurement, assess the influence of different degrees of valve calcification on measurement outcomes, and compare the time between the two and the accuracy of recommended valve sizes. Methods Clinical and imaging data from 138 patients with aortic stenosis who underwent aorta computed tomography angiography(CTA)were retrospectively collected. The area, circumference, maximum diameter, and minimum diameter of the aortic annulus, distance to the left and right coronary arteries, maximum diameter and minimum diameter of the ascending aorta, left ventricular outflow tract, sinotubular junction, and distance from the coronary sinus to the contralateral commissure were measured by manual method and automatic software, and the measurement time was recorded. Pearsons correlation coefficient(r)and intraclass correlation coefficient(ICC)were used to compare correlation and consistency, and Bland-Altman was plotted to further analyze the differences. The patients were categorized based on the extent of valve calcification, and the correlation and consistency among the different subgroups were compared, and a paired t-test was used to compare the time of measurements. The Kappa test was used to evaluate the consistency between the valve size recommended by the two methods and the actual valve size. Results Among the 138 patients, 93 were male, with a mean age of 64 years. All patients presented tricuspid aortic valves and 80.4% exhibited mild or higher aortic regurgitation. Automatic measurement was in good correlation and consistency with manual measurement, with the r values of 0.844-0.990 and the ICC values of 0.841-0.988, and the r and ICC values of the area of aortic annulus were the highest, respectively 0.990 and 0.988. A total of 96 patients exhibited moderate to severe cardiac valve calcification, and there was a high correlation and consistency between manual and automatic measurements in different subgroups, with both the r and ICC values exceeding 0.8. Automated measurement significantly shortened measurement time ［3 min(29±24)s vs. 8 min(14±36)s, P<0.001］. The Kappa value between the recommended valve size based on automatic measurement of the annulus area, circumference, and average diameter and the actual valve type was 0.886, 0.765, and 0.761, respectively. Conclusion The ValvePlus provides reliable information on anatomical parameters of the aortic root before TAVR, demonstrating high correlation and consistency with manual measurements in various calcification subgroups, while significantly reducing the time required for measurements, and the recommended valve size based on automatic measurement is accurate, which can help the TAVR team make accurate assessments and guide valve size selection.

Key words: Transcatheter aortic valve replacement, Aortic stenosis, Aortic annulus, CT angiography

中图分类号:

R445.3

黄书苑,于鑫鑫,杨宝珠,王锡明. 自动软件在经导管主动脉瓣置换术前评估中的价值:与手动测量的对比研究[J]. 山东大学学报 (医学版), 2024, 62(11): 22-31.

HUANG Shuyuan, YU Xinxin,YANG Baozhu, WANG Ximing. Value of automated software in the preoperative evaluation of transcatheter aortic valve replacement: a comparative study with manual measurement[J]. Journal of Shandong University (Health Sciences), 2024, 62(11): 22-31.

参考文献

[1] Rana M. Aortic Valve Stenosis: Diagnostic approaches and recommendations of the 2021 ESC/EACTS guidelines for the management of valvular heart disease-A review of the literature[J]. Cardiol Cardiovasc Med, 2022, 6(3): 315-324.
[2] Herrera RA, Smith MM, Mauermann WJ, et al. Perioperative management of aortic stenosis in patients undergoing non-cardiac surgery [J]. Front Cardiovasc Med, 2023, 10: 1145290. doi:10.3389/fcvm.2023.1145290.
[3] Avvedimento M, Tang GHL. Transcatheter aortic valve replacement(TAVR): recent updates [J]. Prog Cardiovasc Dis, 2021, 69: 73-83. doi: 10.1016/j.pcad.2021.11.003.
[4] Waksman R, Corso PJ, Torguson R, et al. TAVR in low-risk patients: 1-year results from the LRT trial [J]. JACC Cardiovasc Interv, 2019, 12(10): 901-907.
[5] Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement in low-risk patients at five years [J]. New Engl J Med, 2023, 389(21): 1949-1960.
[6] Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation(TAVI)/transcatheter aortic valve replacement(TAVR)[J]. JACC Cardiovasc Imaging, 2019, 12(1): 1-24.
[7] Barbanti M, Yang TH, Rodès Cabau J, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement [J]. Circulation, 2013, 128(3): 244-253.
[8] 张亚博, 管枢, 党晋晋,等. CT TAVI Planning技术在经导管主动脉置换术前的预测性研究 [J]. 心肺血管病杂志, 2020, 39(06): 716-720. ZHANG Yabo, GUAN Shu, DANG Jinjin, et al. Predictive study of CT transcatheter aortic valve implantation planning technology before transcatheter aortic replacement[J]. Journal of Cardiovascular and Pulmonary Diseases, 2020, 39(6): 716-720.
[9] Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research [J]. J Chiropr Med, 2016, 15(2): 155-163.
[10] Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research [J]. Malawi Med J, 2012, 24(3): 69-71.
[11] Kalogeropoulos AS, Redwood SR, Allen CJ, et al. A 20-year journey in transcatheter aortic valve implantation: evolution to current eminence [J]. Front Cardiovasc Med, 2022, 9: 971762. doi: 10.3389/fcvm.2022.971762.
[12] Pibarot P, Salaun E, Dahou A, et al. Echocardiographic results of transcatheter versus surgical aortic valve replacement in low-risk patients: the PARTNER 3 trial [J]. Circulation, 2020, 141(19): 1527-1537.
[13] Forrest JK, Deeb GM, Yakubov SJ, et al. 3-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis [J]. J Am Coll Cardiol, 2023, 81(17): 1663-1674.
[14] Makkar RR, Thourani VH, Mack MJ, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement [J]. N Engl J Med, 2020, 382(9): 799-809.
[15] Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: a review [J]. JAMA, 2021, 325(24): 2480-2494.
[16] 韩康宁, 马晓腾, 杜俣,等. 中国人群主动脉瓣狭窄的特点[J]. 心肺血管病杂志, 2021, 40(9): 990-991, 1000.
[17] Xiong TY, Li YM, Yao YJ, et al. Anatomical characteristics of patients with symptomatic severe aortic stenosis in China [J]. Chin Med J(Engl), 2021, 134(22): 2738-2740.
[18] Francone M, Budde RPJ, Bremerich J, et al. CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology(ESCR)[J]. Eur Radiol, 2019, 30(5): 2627-2650.
[19] 胡春强, 李伟, 赵维鹏,等. 超声心动图在经导管主动脉瓣置换术前评估与术后随访中的应用价值 [J]. 中华医学超声杂志(电子版), 2021, 18(10): 948-953. HU Chunqiang, LI Wei, ZHAO Weipeng, et al. Application value of echocardiography in pre-procedure evaluation and post-procedure follow-up in transcatheter aortic valve replacement [J]. Chinese Journal of Medical Ultrasound(Electronic Edition), 2021, 18(10): 948-953.
[20] Ding P, Xu C, Liu Y, et al. Application of three-dimensional transesophageal echocardiography in preoperative evaluation of transcatheter aortic valve replacement[J]. BMC Cardiovasc Disord, 2021, 21(1): 315. doi: 10.1186/s12872-021-02101-7.
[21] Annoni AD, Mancini ME, Carlicchi E, et al. Pre-TAVI aortic annulus sizing: comparison between manual and semi-automated new generation software measurements in operators with different experience [J]. Br J Radiol, 2023, 96(1149): 20220733.doi:10.1259/bjr.20220733.
[22] Saadi RP, Tagliari AP, Saadi EK, et al. Preoperative TAVR planning: how to do it [J]. J Clin Med, 2022, 5, 11(9): 2582. doi: 10.3390/jcm11092582.
[23] 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识(2021版)[J]. 中国介入心脏病学杂志, 2022, 30(1): 7-16. Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association, 2021 Expert Consensus on Clinical Pathway for Transcatheter Aortic Valve Replacement in China [J]. Chinese Circulation Journal, 2022, 30(1): 7-16.
[24] Bax JJ, Delgado V, Hahn RT, et al. Transcatheter aortic valve replacement: role of multimodality imaging in common and complex clinical scenarios [J]. JACC Cardiovasc Imaging, 2020, 13(1): 124-139.
[25] Patsalis PC, Kloppe A, Plicht B, et al. Undersizing but overfilling eliminates the gray zones of sizing for transcatheter aortic valve replacement with the balloon-expandable bioprosthesis [J]. Int J Cardiol Heart Vasc, 2020, 30: 100593. doi: 10.1016/j.ijcha.2020.100593.
[26] 赵龙, 李国奇, 张宏凯,等. 经导管主动脉瓣置换术前主动脉解剖参数与术后并发症的相关性研究 [J]. 中国医药, 2021, 16(4): 512-515. ZHAO Long, LI Guoqi, ZHANG Hongkai, et al. Study on the correlation between anatomical parameters of aorta before transcatheter aortic valve replacement and postoperative complications [J]. China Medicine, 2021, 16(4): 512-515.
[27] Horehledova B, Mihl C, Schwemmer C, et al. Aortic root evaluation prior to transcatheter aortic valve implantation-correlation of manual and semi-automatic measurements[J]. PLoS One, 2018, 28,13(6): e0199732. doi: 10.1371/journal.pone.0199732. eCollection 2018.
[28] 国晶晶, 李东. 解读“国际心血管CT协会TAVI/TAVR相关CT成像的专家共识” [J]. 国际医学放射学杂志, 2019, 42(3): 334-340. GUO Jingjing, LI Dong. Interpretation of computed tomography imaging in the context of transcatheter aortic valve implantation/transcatheter aortic valve replacement: an expert consensus document of the society of cardiovascular computed tomography[J]. International Journal of Medical Radiology, 2019, 42(3): 334-340.
[29] 刘长福, 孙泽瑜, 王晶,等. 经导管主动脉瓣置换术前测量主动脉根部参数的一致性及与短期预后的关联性:基于Anythink和33 mmeennssiioo CT软件比较 [J]. 南方医科大学学报, 2022, 42(11): 1646-1654. LIU Changfu, SUN Zeyu, WANG Jing, et al. Anythink for CT-based aorta root measurements before transcatheter aortic valve replacement: measurement consistency with 3mensio and impact on short-term prognosis[J]. Journal of Southern Medical University, 2022, 42(11): 1646-1654.
[30] Zinsser D, Baumann AB, Winter KS, et al. Semi-automatic CT-angiography based evaluation of the aortic annulus in patients prior to TAVR: interchangeability with manual measurements[J]. Int J Cardiovasc Imaging, 2018, 34(10): 1657-1667.

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