Age and Sex-Related Outcomes in CMR Versus CT-Guided TAVR: A Secondary Analysis of a Randomized Clinical Trial.

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2025-03-13 DOI:10.1016/j.jocmr.2025.101882

Ivan Lechner, Fritz Oberhollenzer, Christina Tiller, Magdalena Holzknecht, Alex Kaser, Ronald K Binder, Can Gollmann-Tepeköylü, Gert Klug, Agnes Mayr, Axel Bauer, Bernhard Metzler, Martin Reindl, Sebastian J Reinstadler

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引用次数: 0

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is the preferred treatment for older patients with severe aortic stenosis with outcomes influenced by age and sex. Computed tomography (CT) is the reference imaging modality for TAVR planning, while cardiac magnetic resonance (CMR) is an emerging alternative for this indication. The aim of this study was to evaluate the impact of age and sex on implantation success in patients undergoing CT- or CMR-guided TAVR.

Methods: This was a secondary analysis of the randomized TAVR-CMR trial comparing TAVR planning by CT or CMR (NCT03831087). Patients were categorized according to the median age (82 years) and sex. Implantation success, defined using the Valve Academic Research Consortium-2 definition (absence of procedural mortality, correct positioning of a single prosthetic valve, and proper prosthetic valve performance), was compared at hospital discharge between age groups and sex for each imaging strategy. All-cause mortality at 6 months was compared between imaging strategies across age groups and sex.

Results: A total of 267 patients (median age 82 [IQR 80-85] years, 50% female) underwent TAVR at two heart centers in Austria between September 2017 and December 2022. Implantation success did not differ significantly between imaging strategies across age and sex subgroups. For patients ≤82 years, success rates were 92.1% (CT) vs. 94.7% (CMR) (p=0.524), and for those >82 years, 89.4% (CT) vs. 91.9% (CMR) (p=0.622). Among female patients, success rates were 84.7% (CT) vs. 93.2% (CMR) (p=0.113), and among male patients, 95.7% (CT) vs. 93.8% (CMR) (p=0.610). All-cause mortality at 6 months did not differ significantly between imaging strategies across age and sex subgroups. Mortality rates for patients ≤82 and >82 years were 4.8% vs. 5.3% (p=0.839) and 9.1% vs. 12.9% (p=0.490) for CT and CMR, respectively. Similarly, female and male patients had comparable mortality rates (10.2% vs. 8.1%, p=0.680; 4.3% vs. 9.4%, p=0.240).

Conclusions: In this secondary analysis of the TAVR-CMR trial, CMR-guided TAVR was associated with similar outcomes compared with CT-guided TAVR irrespective of age and sex.

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背景：经导管主动脉瓣置换术（TAVR）是老年重度主动脉瓣狭窄患者的首选治疗方法，其效果受年龄和性别的影响。计算机断层扫描（CT）是 TAVR 计划的参考成像方式，而心脏磁共振（CMR）则是这一适应症的新兴替代方式。本研究旨在评估在 CT 或 CMR 引导下进行 TAVR 患者的年龄和性别对植入成功率的影响：这是一项比较 CT 或 CMR TAVR 计划的随机 TAVR-CMR 试验（NCT03831087）的二次分析。根据中位年龄（82 岁）和性别对患者进行分类。根据瓣膜学术研究联盟-2（Valve Academic Research Consortium-2）的定义（无手术死亡率、单个人工瓣膜定位正确、人工瓣膜性能良好），比较了每种成像策略下不同年龄组和性别患者出院时的植入成功率。比较了不同年龄组和性别的成像策略在 6 个月内的全因死亡率：2017年9月至2022年12月期间，共有267名患者（中位年龄82 [IQR80-85]岁，50%为女性）在奥地利的两家心脏中心接受了TAVR。在不同年龄和性别的亚组中，不同成像策略的植入成功率没有显著差异。对于年龄小于82岁的患者，成功率为92.1%（CT）对94.7%（CMR）（P=0.524）；对于年龄大于82岁的患者，成功率为89.4%（CT）对91.9%（CMR）（P=0.622）。女性患者的成功率为 84.7%（CT）对 93.2%（CMR）（P=0.113），男性患者的成功率为 95.7%（CT）对 93.8%（CMR）（P=0.610）。不同年龄和性别亚组的患者在 6 个月内的全因死亡率在不同成像策略之间没有显著差异。≤82岁和大于82岁患者的死亡率分别为：CT 4.8%对5.3%（P=0.839）和CMR 9.1%对12.9%（P=0.490）。同样，女性和男性患者的死亡率相当（10.2% vs. 8.1%，p=0.680；4.3% vs. 9.4%，p=0.240）：在这项TAVR-CMR试验的二次分析中，无论年龄和性别，CMR引导的TAVR与CT引导的TAVR相比，结果相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.