Noncoronary Gated Transcatheter Aortic Valve Replacement Computed Tomography Scans Can Safely Replace Invasive Coronary Angiography Pre-Transcatheter Aortic Valve Replacement

Khan, Sarosh; Gedela, Srinubabu; Frost, Olivia M.T.; Galinato, Michael; Crawford, Iveta; Smith, Sheila M.; Fawaz, Samer; Simpson, Rupert; Singh, Avadhesh Pratap; Karamasis, Grigoris V.; Davies, John R.; Aggarwal, Rajesh; Jagathesan, Rohan; Cook, Christopher

doi:10.1016/j.shj.2022.100123

Structural Heart

2023

DOI: 10.1016/j.shj.2022.100123

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Noncoronary Gated Transcatheter Aortic Valve Replacement Computed Tomography Scans Can Safely Replace Invasive Coronary Angiography Pre-Transcatheter Aortic Valve Replacement

Sarosh Khan

Srinubabu Gedela

Olivia M.T. Frost

et al.

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2024

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“…Sensitivity, specificity, positive and negative predictive value on the patient level, comparing coronary computed tomography with invasive angiography using a cut-off value of 50% lumen stenosis. Studies were stratified by year of publication[27][28][29][30]32,[34][35][36][37]40,41,[43][44][45]47,[49][50][51]53].…”

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confidence: 99%

“…Frequency of at least 50% stenosis in invasive coronary angiography across the included studies. The frequency of ≥50% stenosis was calculated as the sum of true positives and false negatives provided[27][28][29][30]32,[34][35][36][37]40,41,[43][44][45]47,[49][50][51]53].…”

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confidence: 99%

“…Association between frequency of coronary stenoses (>50%) or frequency of atrial fibrillation in the study cohort and the positive predictive value (PPV, red line) or 1-negative predictive value (NPV, blue line) in the studies based on the results of the meta-regression analysis. For details see text[27][28][29][30]32,[34][35][36][37]40,41,[43][44][45]47,[49][50][51]53].…”

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confidence: 99%

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Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients

Diller,

Gerwing,

Boroni Grazioli

et al. 2024

JCM

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Background: Coronary CT angiography (CCTA) may detect coronary artery disease (CAD) in transcatheter aortic valve implantation (TAVI) patients and may obviate invasive coronary angiography (ICA) in selected patients. We assessed the diagnostic accuracy of CCTA for detecting CAD in TAVI patients based on published data. Methods: Meta-analysis and meta-regression were performed based on a comprehensive electronic search, including relevant studies assessing the diagnostic accuracy of CCTA in the setting of TAVI patients compared to ICA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated on a patient and per segment level. Results: Overall, 27 studies (total of 7458 patients) were included. On the patient level, the CCTA’s pooled sensitivity and NPV were 95% (95% CI: 93–97%) and 97% (95% CI: 95–98%), respectively, while the specificity and PPV were at 73% (95% CI: 62–82%) and 64% (95% CI: 57–71%), respectively. On the segmental coronary vessel level, the sensitivity and NPV were 90% (95% CI: 79–96%) and 98% (95% CI: 97–99%). Conclusions: This meta-analysis highlights CCTA’s potential as a first-line diagnostic tool although its limited PPV and specificity may pose challenges when interpreting heavily calcified arteries. This study underscores the need for further research and protocol standardization in this area.

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confidence: 99%

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Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients

Diller,

Gerwing,

Boroni Grazioli

et al. 2024

JCM

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How to address the coronaries in TAVI candidates: can the need for revascularization be safely determined by CT angiography only?

Mascherbauer,

Lamm,

Kammerlander

et al. 2024

European Heart Journal - Imaging Methods and Practice

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Coronary artery disease (CAD) remains one of the most frequent comorbidities among transcatheter aortic valve implantation (TAVI) candidates. Whether routine assessment of CAD by invasive coronary angiography (CA) and eventual peri-procedural percutaneous coronary intervention (PCI) is generally beneficial in TAVI patients has recently been heavily questioned. CA carries significant risks, such as kidney injury, bleeding, and prolonged hospital stay, and may frequently be unnecessary if significant stenoses of the proximal coronary segments can be ruled out on computed tomography angiography. Moreover, the benefits of pre-emptive coronary revascularization at the time of TAVI are not well defined. Despite these facts and weak guideline recommendations, CA and eventual PCI of stable significant coronary lesions at the time of TAVI remain common practice. However, ongoing randomized trials currently challenge the efficacy of such strategies to enable a more streamlined, individualized, and resource-sparing treatment with TAVI.

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Preprocedural assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation: Rationale and design of the EASE‐IT CT registry

Mascherbauer,

Rudolph,

Strauch

et al. 2024

Eur J Clin Investigation

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BackgroundInvasive coronary angiography (ICA) is the standard for pre‐procedural assessment of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI). However, it requires hospitalization and can be associated with complications. Computed tomography angiography (CTA) may be a viable alternative to rule out prognostically relevant CAD.MethodsThe EASE‐IT CT Registry is an investigator‐initiated, prospective, observational, multicentre pilot registry involving patients aged ≥75 years with severe aortic stenosis (AS) intended to implant a transcatheter heart valve (THV) of the SAPIEN family. A total of 150 patients will be recruited from four sites in Germany and Austria. The registry will consist of two prospective cohorts: the investigational CTA‐only cohort and the CTA + ICA control cohort. The CTA‐only cohort will enrol 100 patients in whom significant (≥50%) left main (LM) and/or proximal left anterior descending artery (LAD) stenosis are ruled out on CTA. The CTA + ICA control cohort will enrol 50 patients who have undergone both CTA and ICA before TAVI and in whom ≥50% LM/proximal LAD stenosis has been ruled out by CTA. Three composite endpoints will be assessed at 3 months post‐TAVI: CAD‐specific endpoints, VARC‐3‐defined device success and early safety.ConclusionThe EASE‐IT CT Registry evaluates whether TAVI can be carried out safely without performing ICA if prognostically relevant CAD of the LM/proximal LAD is ruled out with CTA. If so, the omission of ICA would help streamline the pre‐procedural workup of TAVI patients.

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Noncoronary Gated Transcatheter Aortic Valve Replacement Computed Tomography Scans Can Safely Replace Invasive Coronary Angiography Pre-Transcatheter Aortic Valve Replacement

Cited by 3 publications

References 4 publications

Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients

Utility of Coronary Computed Tomography Angiography in Patients Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis and Meta-Regression Based on Published Data from 7458 Patients

How to address the coronaries in TAVI candidates: can the need for revascularization be safely determined by CT angiography only?

Preprocedural assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation: Rationale and design of the EASE‐IT CT registry

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