Your browser doesn't support javascript.
loading
Coronary CT Fractional Flow Reserve before Transcatheter Aortic Valve Replacement: Clinical Outcomes.
Aquino, Gilberto J; Abadia, Andres F; Schoepf, U Joseph; Emrich, Tilman; Yacoub, Basel; Kabakus, Ismail; Violette, Alexis; Wiley, Courtney; Moreno, Andreina; Sahbaee, Pooyan; Schwemmer, Chris; Bayer, Richard R; Varga-Szemes, Akos; Steinberg, Daniel; Amoroso, Nicholas; Kocher, Madison; Waltz, Jeffrey; Ward, Thomas J; Burt, Jeremy R.
Afiliación
  • Aquino GJ; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Abadia AF; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Schoepf UJ; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Emrich T; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Yacoub B; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Kabakus I; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Violette A; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Wiley C; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Moreno A; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Sahbaee P; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Schwemmer C; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Bayer RR; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Varga-Szemes A; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Steinberg D; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Amoroso N; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Kocher M; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Waltz J; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Ward TJ; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
  • Burt JR; From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolin
Radiology ; 302(1): 50-58, 2022 01.
Article en En | MEDLINE | ID: mdl-34609200
ABSTRACT
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.
Asunto(s)
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Cuidados Preoperatorios / Angiografía Coronaria / Reserva del Flujo Fraccional Miocárdico / Reemplazo de la Válvula Aórtica Transcatéter / Angiografía por Tomografía Computarizada Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Año: 2022 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Cuidados Preoperatorios / Angiografía Coronaria / Reserva del Flujo Fraccional Miocárdico / Reemplazo de la Válvula Aórtica Transcatéter / Angiografía por Tomografía Computarizada Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Año: 2022 Tipo del documento: Article