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Routine CT angiography to detect severe coronary artery disease prior to transcatheter aortic valve replacement

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Abstract

Patients undergoing TAVR undergo routine CT angiography (CTA) to assess aorto-iliac pathology and annular dimensions. While coronary CTA may exclude severe CAD in younger patients, its efficacy in defining CAD severity prior to TAVR may be limited. We retrospectively studied 50 consecutive patients undergoing both invasive coronary angiography (ICA) and routine pre-TAVR CTA. Severe CAD was defined as ≥50% stenosis by quantitative coronary angiography and compared to a blinded CTA visual estimation of ≥50% stenosis. The analysis was confined to four segments: left main and three proximal to mid major coronaries to maximize myocardial territory at risk. Coronary assessment was performed using standard reconstructed ECG phases from pre-TAVR chest CTA on a Philips 256 iCT scanner. Nearly ¾ of patients were ≥75 years old, 57% were female, half were diabetic and 45% had prior PCI. By ICA, 49% had significant coronary calcification. The incidence of severe proximal to mid vessel CAD by ICA was 39%. Similarly, a third of patients required PCI prior to TAVR. CTA was unable to exclude severe proximal to mid vessel CAD in 88% of patients in all four segments: non-diagnostic CTA readings were mainly due to calcification (60%) or motion artifact (28%). Non-diagnostic coronary CTA readings ranged from 25 to 72% according to segment analyzed: only the left main segment had diagnostic quality CTA in the majority of patients (p < 0.01). PCI is performed frequently prior to TAVR based upon invasive coronary angiographic assessment. Routine chest CTA algorithms do not provide adequate diagnostic information to exclude severe CAD, primarily due to severe coronary calcification in the TAVR population.

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Funding

This study was funded by Dr. Dauerman’s Research and Education Fund, which has contributions from multiple industry and university sources. There is no federal funding associated with this study.

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Authors and Affiliations

  1. University of Vermont Larner College of Medicine, Burlington, VT, USA

    S. Chava, G. Gentchos, A. Abernethy, B. Leavitt, E. Terrien & H. L. Dauerman

  2. Division of Cardiology, University of Vermont Medical Center, 111 Colchester Avenue, McClure 1, Burlington, VT, 05401, USA

    H. L. Dauerman

Authors
  1. S. Chava
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  2. G. Gentchos
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  3. A. Abernethy
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  4. B. Leavitt
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  5. E. Terrien
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  6. H. L. Dauerman
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Corresponding author

Correspondence to H. L. Dauerman.

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Conflict of interest

Dr. Dauerman is a consultant for Medtronic, Edwards and Boston Scientific and has Research grants from Boston Scientific, Edwards and Medtronic. Dr. Terrien is a consultant for Medtronic and Edwards. The other authors have no other relevant relationships to disclose.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study for TAVR procedures—as this was a retrospective study, informed consent for retrospective data review was waived by the UVM.

Research involving with human and animal studies

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Chava, S., Gentchos, G., Abernethy, A. et al. Routine CT angiography to detect severe coronary artery disease prior to transcatheter aortic valve replacement. J Thromb Thrombolysis 44, 154–160 (2017). https://doi.org/10.1007/s11239-017-1521-1

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  • DOI: https://doi.org/10.1007/s11239-017-1521-1

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