Cardiac computed tomography: beyond ischemic heart disease and preTAVI studies. Experience during a year in a second level hospital

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac disease is generally evaluated by non-ionizing imaging exams, as echocardiogram or magnetic resonance (MRI) and cardiac computed tomography (cCT) is seldom performed due to radiation concerns, but this exam has some advantages as better spatial resolution or better assessment of calcifications. Depending on different cardiac procedures, radiation exposure to the patients varies. Published values ranged from 4 mSv approx. for coronary angiography alone to 15 mSv approx. if stenting and ventriculography are added. Apart from coronary angiography, cCT is usually performed to plan transaortic valve implantation (TAVI) but other indications exit. Methods we reviewed cCT performed during a year and selected those not performed to assess coronary stenosis or previous to TAVI procedure. Results There were 18 exams, 50% women, mean age 62.8 years (range 17 to 82). There were no inconclusive exams. There were 10 exams with diagnostic purpose, not for measuring different structures. Among them, suspected diagnosis was confirmed in 2 cases. Reasons to choose cCT were: better assessment of calcium (6 cases), better spatial resolution (11), contraindications to MRI (3: 1 due to claustrophobia, 2 due to intracardiac device). 3 exams had 2 reasons (better spatial resolution+ assessment of calcium). 4 exams were performed without contrast, only to assess calcification: 1 case the pericardium, 3 cases the aortic valve. In the rest, contrast was used, assessing coronary anatomy as well in 5 of them. Among them, calcification was also assessed in other 2 cases (pericardium in constrictive pericarditis and mitral annulus in a woman with previous coronary artery by-pass grafting in whom a new mitral intervention was planned). Mean Radiation exposure was 5.5 mSv (range 0.3 to 15.3). There were 9 prospective cases (4 women), with a mean age of 61.6 years (17 to 82 years). Radiation exposure was 1.9 mSv (0.3 to 5.9). Mean age in retrospective studies was 63.8 years (53 to 81). 5 women underwent a retrospective study. Radiation exposure in retrospective studies was 8.7 mSv (3.9 to 15.3). There were no complications. We can see images from the prospective and retrospective studies in figures 1 and 2 respectively. Conclusions Although is seldom performed, cCT can be used safely to assess different cardiac structures. In different cases in which other imaging techniques is not enough, cCT is a good option to evaluate different structures or ventricular function. Several structures can be assessed in the same exploration.