RSNA 2011 

Abstract Archives of the RSNA, 2011


LL-CAS-WE5B

Diagnostic Accuracy of Dual-Source Computed Tomography Coronary Angiography in Patients Undergoing Evaluation for Transcatheter Aortic Valve Implantation

Scientific Informal (Poster) Presentations

Presented on November 30, 2011
Presented as part of LL-CAS-WE: Cardiac

Participants

Philipp Blanke, Presenter: Nothing to Disclose
Gregor Pache MD, Abstract Co-Author: Nothing to Disclose
Stefan Bulla MD, Abstract Co-Author: Nothing to Disclose
Mathias F. J. Langer MD, PhD, Abstract Co-Author: Nothing to Disclose

PURPOSE

To prospectively investigate diagnostic accuracy for dual-source computed tomography coronary angiography (CTCA) to diagnose significant coronary artery stenosis compared with catheter coronary angiography (CCA) in patients with severe aortic stenosis undergoing assessment of aortic root anatomy for transcatheter aortic valve implantation (TAVI).

METHOD AND MATERIALS

One-hundred-twenty consecutive patients (64/56 female/male, mean age 79.0±10.9 years) with severe aortic stenosis (0.7±0.1 aortic valve area cm2) underwent a specific dual-source computed tomography protocol for evaluation of aortic root and coronay anatomy prior to TAVI. CCA was considered the standard of reference.

RESULTS

Mean heart rate was 73.0±15.9 beats/min. Thirty-four (28%) patients had nonsinus rhythm. Prevalence of coronary calcifications was 98% (117 of 120). Mean Agatston score was 873 (median 475 ; range 0–7412). CCA identified 112 significantly stenosed segments in 46 patients. One-hundred-thirty-nine of 1699 segments (8%) in 43 patients were considered nondiagnostic with computed tomography because of calcium (n=116), motion artifacts (n = 17) or stents (n=6). On a patient-based analysis, considering non-diagnostic segments as false positive, sensitivity, specificity and positive and negative predictive values for the detection of significant lesions (≥50% diameter stenosis) were 100%, 68%, 66% and 100%, respectively.

CONCLUSION

In patients undergoing DSCT for assessment of aortic root anatomy prior to TAVI, ruling out of significant coronary artery disease is impaired in a considerable portion of patients due to high calcium burden or heart rhythm irregularities.

CLINICAL RELEVANCE/APPLICATION

Necessary exclusion of significant coronary artery disease prior to TAVI using cardiac CT-data sets for aortic root evaluation may be hampered by high calcium burden and heart rate irregularities.

Cite This Abstract

Blanke, P, Pache, G, Bulla, S, Langer, M, Diagnostic Accuracy of Dual-Source Computed Tomography Coronary Angiography in Patients Undergoing Evaluation for Transcatheter Aortic Valve Implantation.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015803.html