Diagnostic accuracy of dual-source computed tomography coronary angiography in patients undergoing evaluation for transcatheter aortic valve implantation

Abstract

Ziele: To prospectively investigate diagnostic accuracy for dual-source computed tomography coronary angiography (CTCA) to diagnose significant coronary artery stenosis compared with catheter coronary angiography (CCA) in patients with severe aortic stenosis undergoing assessment of aortic root anatomy for transcatheter aortic valve implantation (TAVI). Methode: One-hundred-twenty consecutive patients (64/56 female/male, mean age 79.0±10.9 years) with severe aortic stenosis (0.7±0.1 aortic valve area cm2) underwent a specific dual-source computed tomography protocol for evaluation of aortic root and coronay anatomy prior to TAVI. CCA was considered the standard of reference. Ergebnis: Mean heart rate was 73.0±15.9 beats/min. Thirty-four (28%) patients had nonsinus rhythm. Prevalence of coronary calcifications was 98% (117 of 120). Mean Agatston score was 873 (median 475; range 0–7412). CCA identified 112 significantly stenosed segments in 46 patients. One-hundred-thirty-nine of 1699 segments (8%) in 43 patients were considered nondiagnostic with computed tomography because of calcium (n=116), motion artifacts (n=17) or stents (n=6). On a patient-based analysis, considering non-diagnostic segments as false positive, sensitivity, specificity and positive and negative predictive values for the detection of significant lesions (≥50% diameter stenosis) were 100%, 68%, 66% and 100%, respectively. Schlussfolgerung: In patients undergoing DSCT for assessment of aortic root anatomy prior to TAVI, ruling out of significant coronary artery disease is impaired in a considerable portion of patients due to high calcium burden or heart rhythm irregularities.