Micheas Zemedkun1, Troy M LaBounty2, Geoffrey Bergman1, Shing-Chiu Wong1, Fay Y Lin1, Dolores Reynolds1, Millie Gomez3, Allison M Dunning1, Jonathon Leipsic4, James K Min5. 1. Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 2. Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 3. Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 4. Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 5. Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu.
Abstract
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral approach, although many candidates being considered for TAVR are at increased risk of contrast-induced nephropathy (CIN). OBJECTIVE: To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians and nonagenarians at risk of CIN. APPROACH: We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33). We compared clinical characteristics, CTA image quality (score 1-4) and interpretability, and clinical outcomes, including CIN and vascular complications. RESULTS: The mean age was 88.5±4.0 years, 37% were male, and chronic renal insufficiency was common in both the standard and low-dose contrast cohorts (57% vs. 70%, P=.39). The low-dose contrast protocol was associated with a significantly less contrast volume compared to standard contrast protocol (127±18 ml vs 76±55 ml, P<.001). Individuals imaged using low-dose (n=16) versus standard (n=17) contrast protocols received 80% less contrast volume (23±10 vs. 125±23 ml, P<.001). There was similar graded image quality (3.8±0.4 vs. 3.9±0.3, P=.76) and interpretability (100% for each, P=1.0) between standard and low-dose contrast protocol groups. There was no significant difference in rates of CIN after CTA between standard and low-dose contrast protocol groups (10% vs. 3%, P=.55), with no CIN events in those imaged by low-dose CTA. There were no major vascular injuries associated with TAVR or pigtail insertion, no major bleeding for CTA, and no noninterpretable studies in all patients. CONCLUSION: In this proof-of-principle study, a low-dose contrast protocol appears feasible and safe in octogenarians and nonagenarians undergoing screening for TAVR, and results in significant reduction in contrast load as compared to a standard contrast protocol without observed differences in image quality or safety.
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral approach, although many candidates being considered for TAVR are at increased risk of contrast-induced nephropathy (CIN). OBJECTIVE: To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians and nonagenarians at risk of CIN. APPROACH: We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33). We compared clinical characteristics, CTA image quality (score 1-4) and interpretability, and clinical outcomes, including CIN and vascular complications. RESULTS: The mean age was 88.5±4.0 years, 37% were male, and chronic renal insufficiency was common in both the standard and low-dose contrast cohorts (57% vs. 70%, P=.39). The low-dose contrast protocol was associated with a significantly less contrast volume compared to standard contrast protocol (127±18 ml vs 76±55 ml, P<.001). Individuals imaged using low-dose (n=16) versus standard (n=17) contrast protocols received 80% less contrast volume (23±10 vs. 125±23 ml, P<.001). There was similar graded image quality (3.8±0.4 vs. 3.9±0.3, P=.76) and interpretability (100% for each, P=1.0) between standard and low-dose contrast protocol groups. There was no significant difference in rates of CIN after CTA between standard and low-dose contrast protocol groups (10% vs. 3%, P=.55), with no CIN events in those imaged by low-dose CTA. There were no major vascular injuries associated with TAVR or pigtail insertion, no major bleeding for CTA, and no noninterpretable studies in all patients. CONCLUSION: In this proof-of-principle study, a low-dose contrast protocol appears feasible and safe in octogenarians and nonagenarians undergoing screening for TAVR, and results in significant reduction in contrast load as compared to a standard contrast protocol without observed differences in image quality or safety.
Authors: Todd C Pulerwitz; Omar K Khalique; Tamim N Nazif; Anna Rozenshtein; Gregory D N Pearson; Rebecca T Hahn; Torsten P Vahl; Susheel K Kodali; Isaac George; Martin B Leon; Belinda D'Souza; Ming Jack Po; Andrew J Einstein Journal: J Cardiovasc Comput Tomogr Date: 2016-03-28
Authors: Marco V Usai; Mirjam Gerwing; Antje Gottschalk; Peter Sporns; Walter Heindel; Alexander Oberhuber; Moritz Wildgruber; Michael Köhler Journal: PLoS One Date: 2019-09-10 Impact factor: 3.240