Đánh giá hẹp động mạch chủ bằng cộng hưởng từ tim mạch: một đánh giá có hệ thống và phân tích tổng hợp

Journal of Cardiovascular Magnetic Resonance - Tập 22 - Trang 1-9 - 2020
Kei Woldendorp1,2,3,4, Paul G. Bannon1,2,3, Stuart M. Grieve1,2,5
1Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
2Sydney Medical School, The University of Sydney, Camperdown, Australia
3Baird Institute of Applied Heart & Lung Surgical Research, Newtown, Australia
4Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
5Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia

Tóm tắt

Khi tuổi trung bình của bệnh nhân bị hẹp động mạch chủ nặng (AS) cần can thiệp ngày càng cao, nhu cầu về các phương pháp không xâm lấn cung cấp chẩn đoán chính xác và lập kế hoạch phẫu thuật trở nên ngày càng quan trọng. Những tiến bộ trong cộng hưởng từ tim mạch (CMR) trong hai thập kỷ qua cho phép cung cấp dữ liệu huyết động học tại van động mạch chủ, cùng với hình ảnh giải phẫu có độ trung thực cao. Các cơ sở dữ liệu điện tử đã được tìm kiếm cho các nghiên cứu so sánh CMR với siêu âm tim qua thành ngực (TTE) và siêu âm tim qua thực quản (TEE) trong chẩn đoán hẹp động mạch chủ. Các nghiên cứu chỉ được bao gồm nếu có sự so sánh trực tiếp trên những bệnh nhân được ghép cặp, và nếu chẩn đoán chủ yếu thông qua việc đo diện tích van động mạch chủ (AVA). Hai mươi ba bài báo có liên quan, có khảo sát theo hướng tiếp cận trong tương lai đã được đưa vào phân tích tổng hợp, tổng cộng 1040 bệnh nhân cá thể. Không có sự khác biệt đáng kể nào trong việc đo AVA giữa CMR so với TEE. Các phép đo AVA bằng CMR lớn hơn so với TTE trung bình 10,7% (chênh lệch tuyệt đối: + 0,14cm2, 95% CI 0,07–0,21, p < 0,001). Độ tin cậy cao cho cả các phép đo giữa các quan sát viên và trong cùng một quan sát viên (0,03cm2 +/− 0,04 và 0,02cm2 +/− 0,01, tương ứng). Phân tích của chúng tôi cho thấy sự tương đương của các phép đo AVA sử dụng CMR so với những phép đo thu được từ TEE. CMR đã cho thấy AVA lớn hơn một cách nhỏ nhưng có ý nghĩa so với TTE. Tuy nhiên, điều này có thể được cho là do các lỗi đã biết trong việc xác định kích thước phễu động mạch thất trái như được đo bằng TTE. Bằng cách cung cấp đánh giá giải phẫu bổ sung, CMR được coi là công cụ chính trong việc đánh giá và khảo sát bệnh nhân hẹp động mạch chủ nặng, những người là ứng viên cho can thiệp phẫu thuật hoặc thông qua ống catheter.

Từ khóa


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