Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-out Significant Coronary Artery Disease

Robin F Gohmann; Philipp Lauten; Patrick Seitz; Christian Krieghoff; Christian Lücke; Sebastian Gottschling; Meinhard Mende; Stefan Weiß; Johannes Wilde; Philipp Kiefer; Thilo Noack; Steffen Desch; David Holzhey; Michael A Borger; Holger Thiele; Mohamed Abdel-Wahab; Matthias Gutberlet

doi:10.3390/jcm9061623

Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-out Significant Coronary Artery Disease

J Clin Med. 2020 May 27;9(6):1623. doi: 10.3390/jcm9061623.

Authors

Robin F Gohmann^{1

2}, Philipp Lauten³, Patrick Seitz¹, Christian Krieghoff¹, Christian Lücke¹, Sebastian Gottschling¹, Meinhard Mende⁴, Stefan Weiß⁵, Johannes Wilde³, Philipp Kiefer⁶, Thilo Noack⁶, Steffen Desch^{3

5}, David Holzhey⁶, Michael A Borger^{5

6}, Holger Thiele^{3

5}, Mohamed Abdel-Wahab^{3

5}, Matthias Gutberlet^{1

2

5}

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
² Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany.
³ Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
⁴ Institute of Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstr. 16-18, 04107 Leipzig, Germany.
⁵ Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany.
⁶ Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.

Abstract

Background: Significant coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). Assessment of CAD prior to TAVI is recommended by current guidelines and is mainly performed via invasive coronary angiography (ICA). In this study we analyzed the ability of coronary CT-angiography (cCTA) to rule out significant CAD (stenosis ≥ 50%) during routine pre-TAVI evaluation in patients with high pre-test probability for CAD.

Methods: In total, 460 consecutive patients undergoing pre-TAVI CT (mean age 79.6 ± 7.4 years) were included. All patients were examined with a retrospectively ECG-gated CT-scan of the heart, followed by a high-pitch-scan of the vascular access route utilizing a single intravenous bolus of 70 ml iodinated contrast medium. Images were evaluated for image quality, calcifications, and significant CAD; CT-examinations in which CAD could not be ruled out were defined as positive (CAD⁺). Routinely, patients received ICA (388/460; 84.3%; Group A), which was omitted if renal function was impaired and CAD was ruled out on cCTA (Group B). Following TAVI, clinical events were documented during the hospital stay.

Results: cCTA was negative for CAD in 40.2% (188/460). Sensitivity, specificity, PPV, and NPV in Group A were 97.8%, 45.2%, 49.6%, and 97.4%, respectively. Median coronary artery calcium score (CAC) was higher in CAD⁺-patients but did not have predictive value for correct classification of patients with cCTA. There were no significant differences in clinical events between Group A and B.

Conclusion: cCTA can be incorporated into pre-TAVI CT-evaluation with no need for additional contrast medium. cCTA may exclude significant CAD in a relatively high percentage of these high-risk patients. Thereby, cCTA may have the potential to reduce the need for ICA and total amount of contrast medium applied, possibly making pre-procedural evaluation for TAVI safer and faster.

Keywords: aortic stenosis; computed tomography coronary angiography; coronary angiography; coronary artery disease; diagnostic accuracy; transcatheter aortic valve implantation.