Computed Tomography Angiography for the Diagnosis of Coronary Artery Disease Among Patients Undergoing Transcatheter Aortic Valve Implantation

Overview

Journal J Cardiovasc Transl Res

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2021 Feb 5

PMID 33543417

Citations 10

Authors

David Meier

Arnaud Depierre

Antoine Topolsky

Christan Roguelov

Marion Dupre

Vladimir Rubimbura

Eric Eeckhout

Salah Dine Qanadli

Olivier Muller

Thabo Mahendiran

David Rotzinger

Stephane Fournier

Affiliations

Soon will be listed here.

Abstract

Background: Computed tomography angiography (CTA) is used to plan TAVI procedures. We investigated the performance of pre-TAVI CTA for excluding coronary artery disease (CAD).

Methods: In total 127 patients were included. CTA images were analyzed for the presence of ≥ 50% (significant CAD) and ≥ 70% (severe CAD) diameter stenoses in proximal coronary arteries. Results were compared with invasive coronary angiography (ICA) at vessel and patient levels. Primary endpoint was the negative predictive value (NPV) of CTA for the presence of CAD.

Results: A total of 342 vessels were analyzable. NPV of CTA was 97.5% for significant CAD and 96.3% for severe CAD. Positive predictive value and accuracy were 44.8% and 87.1% for significant CAD and 56.3% and 94.4% for severe CAD. At patient level, NPV for significant CAD was 88.6%.

Conclusion: Pre-TAVI CTA shows good performance for ruling out CAD and could be used as a gatekeeper for ICA in selected patients.

Citing Articles

Coronary CTA and CT-FFR in trans-catheter aortic valve implantation candidates: a systematic review and meta-analysis.

Becker L, Peper J, van Ginkel D, Overduin D, van Es H, Rensing B Eur Radiol. 2024; 35(3):1552-1569.

PMID: 39738560 DOI: 10.1007/s00330-024-11211-7.

Saudi Heart Association/National Heart Center/Saudi Arabian Cardiac Interventional Society/Saudi Society for Cardiac Surgeons/Saudi Cardiac Imaging Group 2023 TAVI Guidelines.

Albacker T, Tash A, Alamri H, Alasnag M, AlKashkari W, AlMutairi F J Saudi Heart Assoc. 2024; 36(2):184-231.

PMID: 39234557 PMC: 11373420. DOI: 10.37616/2212-5043.1379.

Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients.

Diller G, Gerwing M, Boroni Grazioli S, De-Torres-Alba F, Radke R, Vormbrock J J Clin Med. 2024; 13(2).

PMID: 38276138 PMC: 10816478. DOI: 10.3390/jcm13020631.

Advanced CT measures of coronary artery disease with intermediate stenosis in patients with severe aortic valve stenosis.

Langenbach M, Langenbach I, Foldyna B, Mauri V, Klein K, Macherey-Meyer S Eur Radiol. 2024; 34(8):4897-4908.

PMID: 38189982 PMC: 11255039. DOI: 10.1007/s00330-023-10549-8.

Investigating the Influence of High-Speed Gantry Rotation in Cardiac CT on Motion Artifacts in Aortic Stenosis Patients Not Premedicated with β-Blockers: The FAST-CCT Randomized Trial Protocol.

Fahrni G, Gullo G, Touray A, Fournier S, Jouannic A, Lu H J Cardiovasc Dev Dis. 2023; 10(10).

PMID: 37887871 PMC: 10607475. DOI: 10.3390/jcdd10100424.

References

Leon M, Smith C, Mack M, Makkar R, Svensson L, Kodali S . Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016; 374(17):1609-20. DOI: 10.1056/NEJMoa1514616. View

Nishimura R, Otto C, Bonow R, Carabello B, Erwin 3rd J, Guyton R . 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129(23):e521-643. DOI: 10.1161/CIR.0000000000000031. View

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm P . 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36):2739-2791. DOI: 10.1093/eurheartj/ehx391. View

Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min J, Leipsic J . SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2012; 6(6):366-80. DOI: 10.1016/j.jcct.2012.11.002. View

van den Boogert T, Vendrik J, Claessen B, Baan J, Beijk M, Limpens J . CTCA for detection of significant coronary artery disease in routine TAVI work-up : A systematic review and meta-analysis. Neth Heart J. 2018; 26(12):591-599. PMC: 6288031. DOI: 10.1007/s12471-018-1149-6. View

Rossi A, De Cecco C, Kennon S, Zou L, Meinel F, Toscano W . CT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic valve replacement. J Cardiovasc Comput Tomogr. 2017; 11(5):338-346. DOI: 10.1016/j.jcct.2017.06.001. View

Strong C, Ferreira A, Teles R, Mendes G, Abecasis J, Cardoso G . Diagnostic accuracy of computed tomography angiography for the exclusion of coronary artery disease in candidates for transcatheter aortic valve implantation. Sci Rep. 2019; 9(1):19942. PMC: 6934755. DOI: 10.1038/s41598-019-56519-3. View

Schroeder S, Kopp A, Kuettner A, Burgstahler C, Herdeg C, Heuschmid M . Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: experience in 94 patients. Clin Imaging. 2002; 26(2):106-11. DOI: 10.1016/s0899-7071(01)00371-0. View

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C . 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019; 41(3):407-477. DOI: 10.1093/eurheartj/ehz425. View

10.

Hamdan A, Wellnhofer E, Konen E, Kelle S, Goitein O, Andrada B . Coronary CT angiography for the detection of coronary artery stenosis in patients referred for transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr. 2015; 9(1):31-41. DOI: 10.1016/j.jcct.2014.11.008. View

11.

Danson E, Hansen P, Sen S, Davies J, Meredith I, Bhindi R . Assessment, treatment, and prognostic implications of CAD in patients undergoing TAVI. Nat Rev Cardiol. 2016; 13(5):276-85. DOI: 10.1038/nrcardio.2016.9. View

12.

Nkomo V, Gardin J, Skelton T, Gottdiener J, Scott C, Enriquez-Sarano M . Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368(9540):1005-11. DOI: 10.1016/S0140-6736(06)69208-8. View

13.

Smith C, Leon M, Mack M, Miller D, Moses J, Svensson L . Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011; 364(23):2187-98. DOI: 10.1056/NEJMoa1103510. View

14.

Mack M, Leon M, Thourani V, Makkar R, Kodali S, Russo M . Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1695-1705. DOI: 10.1056/NEJMoa1814052. View

15.

Opolski M, Kim W, Liebetrau C, Walther C, Blumenstein J, Gaede L . Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation. Clin Res Cardiol. 2015; 104(6):471-80. DOI: 10.1007/s00392-014-0806-z. View

16.

Takx R, Sucha D, Park J, Leiner T, Hoffmann U . Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a Systematic Review. Eur Radiol. 2015; 25(12):3536-42. PMC: 4636517. DOI: 10.1007/s00330-015-3791-3. View

17.

Iung B, Baron G, Tornos P, Gohlke-Barwolf C, Butchart E, Vahanian A . Valvular heart disease in the community: a European experience. Curr Probl Cardiol. 2007; 32(11):609-61. DOI: 10.1016/j.cpcardiol.2007.07.002. View

18.

Harris B, De Cecco C, Schoepf U, Steinberg D, Bayer R, Krazinski A . Dual-source CT imaging to plan transcatheter aortic valve replacement: accuracy for diagnosis of obstructive coronary artery disease. Radiology. 2014; 275(1):80-8. DOI: 10.1148/radiol.14140763. View

19.

Andreini D, Pontone G, Mushtaq S, Bartorelli A, Ballerini G, Bertella E . Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement. Am Heart J. 2014; 168(3):332-9. DOI: 10.1016/j.ahj.2014.04.022. View