Phillip Kim, Presenter: Nothing to Disclose

Harshna Vinodbhai Vadvala MD, Abstract Co-Author: Nothing to Disclose

Andy Kar Wai Chan MD, Abstract Co-Author: Nothing to Disclose

Stacey Verzosa MD, Abstract Co-Author: Nothing to Disclose

Amit Pursnani MD, Abstract Co-Author: Nothing to Disclose

Thomas Mayrhofer, Abstract Co-Author: Nothing to Disclose

Moussa Mansour MD, Abstract Co-Author: Nothing to Disclose

Udo Hoffmann MD, Abstract Co-Author: Nothing to Disclose

Brian Burns Ghoshhajra MD, Abstract Co-Author: Nothing to Disclose

Preprocedural CT angiography (CTA) for pulmonary vein mapping is often performed in addition to nuclear myocardial perfusion imaging to exclude significant coronary disease. Dual-source CTA of Pulmonary veins (CTAPV) can be performed with prospectively ECG-triggered technique (S-PR), or high-pitch helical prospectively ECG-triggered technique (HP). At our institution, both are performed (at physician discretion) with phase targets in systole at end expiration, without premedication. S-PR coronary CTA has been shown to be robust in the setting of arrhythmia. We hypothesized that CTAPV could assess coronaries, potentially obviating the need for SPECT-MPI.

We retrospectively reviewed 100 CTAPV acquired using 128-slice dual source CT, between November 2012 and October 2013, including 50 consecutive S-PR and 50 consecutive HP scans. Two experienced, blinded readers evaluated all available phases on a segmental basis for image quality, radiation dose, artifacts, vessel size, and presence of >=50% stenosis. Diagnostic quality and the proportion of non-evaluable segments were grouped by the presence of artifacts, vessel size (at proximal and distal positions).

100 patients (50 S-PR, 50 HP) and 1412 segments (708 and 704, respectively) were assessed. Both cohorts had similar BMI and mean heart rates (29.7 vs. 30.9 kg/m2; 69.8 vs. 72.1 beats per minute). More segments were evaluable using S-PR versus HP(per vessel 90.1% vs. 68.9%, p<0.001; per patient proximal 80% vs. 40%, p<0.001). On a per-patient basis, 80% (n=40) of S-PR had diagnostic quality proximal segments versus 40% (n=22) in the HP cohort (p<0.001). Per patient, all segments were more evaluable in S-PR (50% vs. 16%, p=0.001). 93.5% of proximal segments at S-PR were diagnostic vs. 66.7% of segments at HP (p<0.001). Of 42 patients(23 S-PR and 19 HP) in atrial fibrililation during acquisition, 166 segments(92 S-PR and 74-HP segments) were assessed, with 95.7%(n=88) vs. 63.5%(n=47) diagnostic segments(p<0.001). 20 S-PR were diagnostic in all proximal segments vs. 7 HP(p=0.001).

S-PR yielded a significantly higher diagnostic fraction of coronary segments vs. HPHP mode, in this cohort not premedicated for coronary assessment. 

 If validated in a carefully prepared cohort optimized for CAD assessment, CTAPV with S-PR could obviate the need for additional testing in the preoperative assessment of atrial fibrillation patients. 

Kim, P, Vadvala, H, Chan, A, Verzosa, S, Pursnani, A, Mayrhofer, T, Mansour, M, Hoffmann, U, Ghoshhajra, B, Feasibility and Potential Value of Coronary Artery Assessment during Pulmonary Vein Isolation Mapping CTA.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016652.html