Prognostic Value of CT-Derived Myocardial Biomarkers: Extracellular Volume Fraction and Strain in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis
Department of Radiology, The First Hospital of Lanzhou University, The First Clinical Medical College of Lanzhou University, Intelligent Imaging Medical Engineering Research Center of Gansu Province, Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Gansu Province Clinical Research Center for Radiology Imaging, Lanzhou 73000, China
通讯作者
Zixian Chen
来源期刊
Academic radiology
EISSN
1878-4046
出版日期
2024-06-20
摘要
Rationale and objectives: This study aimed to investigate the prognostic value of preoperative CT scan-derived myocardial biomarkers in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Materials and methods: In April 2024, three databases (PubMed, Web of Science and Embase) were searched to identify studies. A random-effects model for meta-analysis was conducted to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) to assess the prognostic value. The I2 statistic was used to assess heterogeneity. Meta-regression analysis was conducted to appraise which variables yielded a significant impact on the HR of included biomarkers.
Results: 11 studies were identified, of which six studies involved 678 patients reporting extracellular volume fraction (ECV), one study involved 300 patients reporting ECV and left ventricular global longitudinal strain (LVGLS), three studies involved 868 patients reporting LVGLS and one study involved 376 patients reporting LVGLS and peak left atrial longitudinal strain (PALS). The endpoints included all-cause mortality, major adverse cardiovascular events (MACE) and a composite outcome of the previous two. The meta-analysis revealed that ECV, whether considered as a dichotomous variable (pooled HR: 3.87, 95% CI: 2.63-5.70, I2 = 0%), or as a continuous variable (pooled HR: 1.12, 95% CI: 1.05-1.19, I2 = 66%), and LVGLS, whether considered as a dichotomous variable (pooled HR: 1.70, 95% CI: 1.30-2.22, I2 = 0%) or a continuous variable (pooled HR: 1.07, 95% CI: 1.04-1.10, I2 = 0%) were all significant predictors for outcomes in patients with severe AS after TAVR. Age, sex, follow-up time and mean pressure gradient had a significant impact on the model of ECV (continuous).
Conclusion: The higher CT-derived ECV and impaired LVGLS are able to predict worse outcomes in patients with severe AS who have undergone TAVR.
Lanzhou science and technology planning project (2020–2D-80); The First Hospital of Lanzhou University Hospital Foundation (ldyyyn2019–78); Gansu Province health industry research project(GSWSKY2023–05); The National College Student Innovation and Entrepreneurship Program (202410730190).
444 Prognostic Value of CT-Derived Myocardial Biomarkers Extracellular Volume Fraction and Strain in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement A Systematic Review and Meta-analysis.pdf
