Ashraf Hamdan1, Ernst Wellnhofer2, Eli Konen3, Sebastian Kelle2, Orly Goitein4, Bogdan Andrada5, Ehud Raanani6, Amit Segev5, Israel Barbash5, Robert Klempfner5, Ilan Goldenberg5, Victor Guetta5. 1. Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel. Electronic address: Ashraf.Hamdan@sheba.health.gov.il. 2. Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. 3. Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel. 4. Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel; Department of Cardiac Surgery, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel. 5. Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel. 6. Department of Cardiac Surgery, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
Abstract
BACKGROUND: Coronary CT has become the foremost noninvasive imaging modality for detecting coronary stenoses in patients with suspected coronary artery disease. Nevertheless, little is known about its performance in patients undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: This study investigates the diagnostic performance of coronary CT angiography in patients referred for TAVR. METHODS: One hundred and fifteen consecutive patients with severe aortic stenosis underwent CT angiography with retrospective electrocardiography triggered acquisition and an iterative reconstruction algorithm, of whom 23 (20%) had prior coronary artery bypass graft (CABG) surgery. Diagnostic accuracy of CT for detecting significant coronary stenosis (≥ 50% luminal diameter stenosis in segments ≥ 2 mm) in the left main, proximal, or middle segments of coronary arteries and bypass grafts was compared with that of invasive coronary angiography. RESULTS: In the overall study population, the sensitivity, specificity, and positive and negative predictive value of CT angiography for the detection of coronary segment or bypass graft lesions were 96% (47 of 49), 73% (48 of 66), 72% (47 of 65), and 96% (48 of 50), respectively. The per-patient diagnostic yield of CT angiography was consistent among patients without prior CABG (93% [28 of 30], 73% [45 of 62], 62% [28 of 45], and 96% [45 of 47], respectively) and among patients with prior CABG (100% [19 of 19], 75% [3 of 4], 95% [19 of 20], and 100% [3 of 3], respectively). CONCLUSION: Among patients referred for TAVR, coronary CT angiography with retrospective gating and iterative reconstruction may allow detection of significant stenosis in the proximal or middle segments of coronary arteries and could permit the evaluation of patients after bypass grafts.
BACKGROUND: Coronary CT has become the foremost noninvasive imaging modality for detecting coronary stenoses in patients with suspected coronary artery disease. Nevertheless, little is known about its performance in patients undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: This study investigates the diagnostic performance of coronary CT angiography in patients referred for TAVR. METHODS: One hundred and fifteen consecutive patients with severe aortic stenosis underwent CT angiography with retrospective electrocardiography triggered acquisition and an iterative reconstruction algorithm, of whom 23 (20%) had prior coronary artery bypass graft (CABG) surgery. Diagnostic accuracy of CT for detecting significant coronary stenosis (≥ 50% luminal diameter stenosis in segments ≥ 2 mm) in the left main, proximal, or middle segments of coronary arteries and bypass grafts was compared with that of invasive coronary angiography. RESULTS: In the overall study population, the sensitivity, specificity, and positive and negative predictive value of CT angiography for the detection of coronary segment or bypass graft lesions were 96% (47 of 49), 73% (48 of 66), 72% (47 of 65), and 96% (48 of 50), respectively. The per-patient diagnostic yield of CT angiography was consistent among patients without prior CABG (93% [28 of 30], 73% [45 of 62], 62% [28 of 45], and 96% [45 of 47], respectively) and among patients with prior CABG (100% [19 of 19], 75% [3 of 4], 95% [19 of 20], and 100% [3 of 3], respectively). CONCLUSION: Among patients referred for TAVR, coronary CT angiography with retrospective gating and iterative reconstruction may allow detection of significant stenosis in the proximal or middle segments of coronary arteries and could permit the evaluation of patients after bypass grafts.
Authors: Gianluca Pontone; Alexia Rossi; Marco Guglielmo; Marc R Dweck; Oliver Gaemperli; Koen Nieman; Francesca Pugliese; Pal Maurovich-Horvat; Alessia Gimelli; Bernard Cosyns; Stephan Achenbach Journal: Eur Heart J Cardiovasc Imaging Date: 2022-03-22 Impact factor: 9.130
Authors: Christopher Strong; António Ferreira; Rui Campante Teles; Gustavo Mendes; João Abecasis; Gonçalo Cardoso; Sara Guerreiro; Pedro Freitas; Ana Coutinho Santos; Carla Saraiva; João Brito; Luís Raposo; Pedro de Araújo Gonçalves; Henrique Mesquita Gabriel; Manuel de Sousa Almeida; Miguel Mendes Journal: Sci Rep Date: 2019-12-27 Impact factor: 4.379