Accuracy of Single-dose Transcatheter Aortic Valve Replacement Planning CT Angiography for the Detection of Coronary Artery Disease.

Abstract

Purpose: To assess the accuracy of transaortic valve replacement (TAVR) planning CT examinations with a broad detector and a single dose of contrast media to diagnose CAD in a large patient cohort.

Materials and methods: In this retrospective study, consecutive patients who underwent a dedicated TAVR planning CT examination with a single contrast media dose and a 320-detector row between November 2017 and March 2021 were screened for inclusion. Inclusion criteria were a complete and correctly performed CT exam as well as an invasive coronary angiography (ICA). The scan consisted of 3 series: (1) ECG-triggered calcium score series over the heart. (2) ECG triggered i.v. CM scanning over the heart covering the entire cardiac cycle (0% to 100%). (3) non-ECG triggered scanning over the thoracic-abdominal area including subclavian and femoral arteries. For 2 and 3, a single i.v. CM bolus was used (300 mg iodine per kg total body weight of iodixanol, minimum 47 mL, maximum 75 mL at 100 kVp; 90 mL at 120 kVp). CT-derived CAD was defined as either free of obstructive CAD (<50%) or showing obstructive disease (>50%), further subclassified in moderate stenosis (50%-70%), or severe stenosis (>70%) for each vessel. ICA data were used as standard of reference.

Results: We studied 599 patients (78.6±7.5 y, 358 men). In ICA, 428 of 2396 coronary vessels (17.8%) demonstrated stenosis of 50% or more. In a per-patient analysis, CTA had a sensitivity of 97.6% and specificity of 84.3% for the detection of patients with at least one vessel with stenosis of 50% or more as well as a NPV and PPV of 97.8% and 82.2%, respectively. In a per-vessel analysis, CTA had 80.8% sensitivity and 88.1% specificity for the detection of stenosis of 50% or more, as well as an NPV and PPV of 95.5% and 59.6%, respectively.

Conclusions: Single-dose TAVR planning CT imaging with a wide detector has high sensitivity and NPV to exclude at least moderate CAD in TAVR candidates.