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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

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CT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic

Alexia Rossi1, Carlo N De Cecco2, Simon R O Kennon1

  • 1NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK.

Journal of Cardiovascular Computed Tomography
|July 1, 2017
PubMed

Insights

Coronary computed tomography angiography (CTA) is questionable for ruling out coronary artery disease (CAD) in transcatheter aortic valve replacement (TAVR) candidates with severe calcifications. However, CTA may be useful in TAVR candidates with less severe coronary calcifications.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Coronary artery disease (CAD) and aortic stenosis share risk factors and pathophysiology.
  • Transcatheter aortic valve replacement (TAVR) is a treatment for severe aortic stenosis.
  • Evaluating CAD in TAVR candidates is crucial for optimal outcomes.

Purpose of the Study:

  • To assess the clinical utility of coronary computed tomography angiography (CTA) in identifying CAD.
  • To determine if CTA can predict the need for revascularization in severe aortic stenosis patients undergoing TAVR.
  • To evaluate CTA's diagnostic performance across different coronary calcification levels.

Main Methods:

  • 140 patients without known CAD undergoing TAVR evaluation were included.
  • Calcium scoring and CTA were performed, with invasive coronary angiography (ICA) as the reference standard.
  • CAD was defined by ≥50% and ≥70% diameter reduction thresholds; revascularization prediction used ≥70% stenosis and high-risk CAD findings.

Main Results:

  • 41% of patients had CAD by the 50% threshold and 16% by the 70% threshold on ICA.
  • CTA and ICA showed similar predictive values for revascularization (OR 3.22 vs. 4.62).
  • CTA's diagnostic performance was superior in patients with low Agatston calcium scores (<400) compared to high scores (AUC 0.81 vs. 0.63).

Conclusions:

  • CTA is questionable for excluding CAD in TAVR candidates with severe coronary calcifications.
  • CTA may have a clinical role in TAVR candidates with less severe coronary calcifications (30% of this cohort).
  • Further research is needed to define CTA's precise role in TAVR patient selection.
Abstract

Keywords:
Aortic stenosisComputed tomography angiographyCoronary artery diseaseSensitivity and specificityTranscatheter valve intervention

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