Embolic Events After Computed Tomography Contrast Injection in Patients With Interatrial Shunts: A Cohort Study
Khoschy Schawkat1,2, Diana Litmanovich3, Elisabeth Appel1,4
1Division of Abdominal Imaging, Department of Radiology.
Insights
Patients with interatrial shunts undergoing computed tomography (CT) scans with intravenous (IV) contrast media do not face an increased risk of paradoxical embolism. This study found no significant difference in cardiac or neurological events when IV contrast was administered without an in-line filter.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Patients with interatrial shunts (e.g., patent foramen ovale, atrial septal defect) may be at risk for paradoxical air embolism after computed tomography (CT) scans with intravenous (IV) contrast.
- Current IV in-line filters are incompatible with the power injection rates required for diagnostic CT scans.
Purpose of the Study:
- To determine if patients with interatrial shunts have a higher incidence of paradoxical embolism to the heart and brain within 48 hours of IV contrast injection compared to controls.
- To assess the risk of cardiac and neurological embolic events following IV contrast administration without an in-line filter in patients with interatrial shunts.
Main Methods:
- Retrospective cohort study at a tertiary academic center involving 2929 patients undergoing 8983 CT scans with IV contrast.
- Interatrial shunt diagnosis confirmed via echocardiography (transthoracic or transesophageal).
- Evaluation of cardiac embolic events (troponin elevation) and neurological embolic events (stroke/transient ischemic attacks).
Main Results:
- Of 2929 patients, 16.2% (475) had an interatrial shunt.
- New elevated troponin occurred in 2.4% of patients with shunts versus 1.5% without.
- New stroke diagnosis occurred in 1% of patients with shunts versus 0.8% without.
Conclusions:
- Intravenous CT contrast administration without an in-line filter does not increase the incidence of cardiac or neurological events in patients with echocardiographic evidence of an interatrial shunt.
- The findings suggest that current practices for IV contrast administration in CT scans are safe for patients with interatrial shunts regarding paradoxical embolism.
Background:
Patients with interatrial shunts (patient foramen ovale/atrial septal defect) are potentially at increased risk for paradoxical air embolism following computed tomography (CT) scans with intravenous (IV) contrast media injection. IV in-line filters aim to prevent such embolisms but are not compatible with power injection required for diagnostic CT.
Purpose:
The purpose of this study was to determine whether the incidence of paradoxical embolism to the heart and brain in patients with an interatrial shunt is higher compared with controls within 48 hours following injection of IV contrast media without IV in-line filter.
Methods:
This is a retrospective cohort study conducted at a large tertiary academic center, which included a total of 2929 consecutive patients who underwent 8983 CT scans with IV contrast media injection between July 1, 2000 and April 30, 2018. Diagnosis of an interatrial shunt was confirmed by transthoracic or transesophageal echocardiography. Incidence and risk of cardiac embolic events (new troponin elevation, >0.1 ng/mL) and neurological embolic events (new diagnosis of stroke/transient ischemic attacks) were evaluated.
Results:
Among the 2929 patients analyzed (mean±SD age, 61±14 y), 475/2929 (16.2%) patients had an interatrial shunt. After applying the exclusion criteria, new elevated troponin was found in 8/329 (2.4%; 95% confidence interval [CI]: 1.1-4.7) patients with an interatrial shunt compared with 25/1687 (1.5%; 95% CI: 0.9-2.2) patients without an interatrial shunt. New diagnosis of stroke occurred in 2/169 (1%; 95% CI: 0.3-4.2) of patients with an interatrial shunt compared with 7/870 (0.8%; 95% CI: 0.4-1.7) without interatrial shunt.
Conclusion:
Among patients with echocardiographic evidence of an interatrial shunt, IV CT contrast administration without an in-line filter does not increase the incidence of cardiac or neurological events.
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