Richard Bayer, Presenter: Nothing to Disclose

Brett S. Harris PhD, Abstract Co-Author: Nothing to Disclose

Felix G. Meinel MD, Abstract Co-Author: Nothing to Disclose

Daniel H. Steinberg MD, Abstract Co-Author: Nothing to Disclose

Carlo Nicola de Cecco MD, Abstract Co-Author: Nothing to Disclose

U. Joseph Schoepf MD, Abstract Co-Author: Research Grant, Bracco Group Research Grant, Bayer AG Research Grant, General Electric Company Research Grant, Siemens AG

Aleksander Krazinski, Abstract Co-Author: Nothing to Disclose

Kevin Dyer, Abstract Co-Author: Nothing to Disclose

Monique Sandhu, Abstract Co-Author: Nothing to Disclose

Michael R. Zile MD, Abstract Co-Author: Nothing to Disclose

Patients referred for transcatheter aortic valve replacement (TAVR) typically undergo a CT study of the heart, aortic root and vascular access route for pre-interventional planning. In this study we evaluated the accuracy of cardiac CT, performed for TAVR planning purposes for diagnosing obstructive coronary artery disease (CAD) using coronary catheter angiography (CCA) as the reference standard.

With institutional review board approval, waiver of informed consent and in HIPAA compliance we retrospectively analyzed the data of 100 consecutive TAVR candidates (61 male, mean age 79.6±9.9 years) who underwent both TAVR planning CT and CCA. The presence and degree of coronary artery stenosis was assessed at both modalities. Additionally, in patients with coronary bypass grafts these were rated as either patent or occluded. Using CCA as the reference standard, we calculated the accuracy of CT for lesion detection on a per-vessel and per-patient basis. We further analyzed the accuracy of CT for the assessment of graft patency.

Our data show that in a per-vessel/per patient analysis, CT had 94.4/98.6% sensitivity and 68.4/55.6% specificity for the detection of >50% stenosis in the native coronary arteries. Negative and positive predictive values were 94.7/93.8% and 67.0/85.7%, respectively. On CT, the per-patient sensitivity for >70% stenosis was found to be 100.0%. Furthermore, all 12 vessels on which percutaneous coronary intervention was performed were correctly identified on CT as demonstrating >50% stenosis. Finally, there was good agreement between CT and CCA regarding graft patency in 114/115 grafts identified on CCA.

Our study indicates that TAVR planning CT does indeed have high sensitivity and negative predictive value in excluding obstructive CAD. For prospective TAVR candidates this would suggest that an additional pre-procedural CCA study may not be required in those patients with a CT negative for obstructive CAD.

Our analysis suggests a new management algorithm that would benefit the rising numbers of TAVR candidates with increases in cost effectiveness and improvements in patient safety.

Bayer, R, Harris, B, Meinel, F, Steinberg, D, de Cecco, C, Schoepf, U, Krazinski, A, Dyer, K, Sandhu, M, Zile, M, CT for Planning Transcatheter Aortic Valve Replacement: Accuracy for Diagnosing Obstructive Coronary Artery Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007217.html