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

<b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. Ausführliche Beschreibung

Gespeichert in:

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

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy

Übergeordnetes Werk:	In: Journal of Clinical Medicine - MDPI AG, 2013, 9(2020), 6, p 1623
Übergeordnetes Werk:	volume:9 ; year:2020 ; number:6, p 1623

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.3390/jcm9061623

Katalog-ID:	DOAJ006441157

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520			\|a <b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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.
650		4	\|a aortic stenosis
650		4	\|a computed tomography coronary angiography
650		4	\|a coronary angiography
650		4	\|a coronary artery disease
650		4	\|a transcatheter aortic valve implantation
650		4	\|a diagnostic accuracy
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700	0		\|a Philipp Lauten \|e verfasserin \|4 aut
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allfields	10.3390/jcm9061623 doi (DE-627)DOAJ006441157 (DE-599)DOAJca9d3ab4519a4565b8efc1e2d76bcad3 DE-627 ger DE-627 rakwb eng Robin F. Gohmann verfasserin aut Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy Medicine R Philipp Lauten verfasserin aut Patrick Seitz verfasserin aut Christian Krieghoff verfasserin aut Christian Lücke verfasserin aut Sebastian Gottschling verfasserin aut Meinhard Mende verfasserin aut Stefan Weiß verfasserin aut Johannes Wilde verfasserin aut Philipp Kiefer verfasserin aut Thilo Noack verfasserin aut Steffen Desch verfasserin aut David Holzhey verfasserin aut Michael A. Borger verfasserin aut Holger Thiele verfasserin aut Mohamed Abdel-Wahab verfasserin aut Matthias Gutberlet verfasserin aut In Journal of Clinical Medicine MDPI AG, 2013 9(2020), 6, p 1623 (DE-627)718632478 (DE-600)2662592-1 20770383 nnns volume:9 year:2020 number:6, p 1623 https://doi.org/10.3390/jcm9061623 kostenfrei https://doaj.org/article/ca9d3ab4519a4565b8efc1e2d76bcad3 kostenfrei https://www.mdpi.com/2077-0383/9/6/1623 kostenfrei https://doaj.org/toc/2077-0383 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2020 6, p 1623
spelling	10.3390/jcm9061623 doi (DE-627)DOAJ006441157 (DE-599)DOAJca9d3ab4519a4565b8efc1e2d76bcad3 DE-627 ger DE-627 rakwb eng Robin F. Gohmann verfasserin aut Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy Medicine R Philipp Lauten verfasserin aut Patrick Seitz verfasserin aut Christian Krieghoff verfasserin aut Christian Lücke verfasserin aut Sebastian Gottschling verfasserin aut Meinhard Mende verfasserin aut Stefan Weiß verfasserin aut Johannes Wilde verfasserin aut Philipp Kiefer verfasserin aut Thilo Noack verfasserin aut Steffen Desch verfasserin aut David Holzhey verfasserin aut Michael A. Borger verfasserin aut Holger Thiele verfasserin aut Mohamed Abdel-Wahab verfasserin aut Matthias Gutberlet verfasserin aut In Journal of Clinical Medicine MDPI AG, 2013 9(2020), 6, p 1623 (DE-627)718632478 (DE-600)2662592-1 20770383 nnns volume:9 year:2020 number:6, p 1623 https://doi.org/10.3390/jcm9061623 kostenfrei https://doaj.org/article/ca9d3ab4519a4565b8efc1e2d76bcad3 kostenfrei https://www.mdpi.com/2077-0383/9/6/1623 kostenfrei https://doaj.org/toc/2077-0383 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2020 6, p 1623
allfields_unstemmed	10.3390/jcm9061623 doi (DE-627)DOAJ006441157 (DE-599)DOAJca9d3ab4519a4565b8efc1e2d76bcad3 DE-627 ger DE-627 rakwb eng Robin F. Gohmann verfasserin aut Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy Medicine R Philipp Lauten verfasserin aut Patrick Seitz verfasserin aut Christian Krieghoff verfasserin aut Christian Lücke verfasserin aut Sebastian Gottschling verfasserin aut Meinhard Mende verfasserin aut Stefan Weiß verfasserin aut Johannes Wilde verfasserin aut Philipp Kiefer verfasserin aut Thilo Noack verfasserin aut Steffen Desch verfasserin aut David Holzhey verfasserin aut Michael A. Borger verfasserin aut Holger Thiele verfasserin aut Mohamed Abdel-Wahab verfasserin aut Matthias Gutberlet verfasserin aut In Journal of Clinical Medicine MDPI AG, 2013 9(2020), 6, p 1623 (DE-627)718632478 (DE-600)2662592-1 20770383 nnns volume:9 year:2020 number:6, p 1623 https://doi.org/10.3390/jcm9061623 kostenfrei https://doaj.org/article/ca9d3ab4519a4565b8efc1e2d76bcad3 kostenfrei https://www.mdpi.com/2077-0383/9/6/1623 kostenfrei https://doaj.org/toc/2077-0383 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2020 6, p 1623
allfieldsGer	10.3390/jcm9061623 doi (DE-627)DOAJ006441157 (DE-599)DOAJca9d3ab4519a4565b8efc1e2d76bcad3 DE-627 ger DE-627 rakwb eng Robin F. Gohmann verfasserin aut Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy Medicine R Philipp Lauten verfasserin aut Patrick Seitz verfasserin aut Christian Krieghoff verfasserin aut Christian Lücke verfasserin aut Sebastian Gottschling verfasserin aut Meinhard Mende verfasserin aut Stefan Weiß verfasserin aut Johannes Wilde verfasserin aut Philipp Kiefer verfasserin aut Thilo Noack verfasserin aut Steffen Desch verfasserin aut David Holzhey verfasserin aut Michael A. Borger verfasserin aut Holger Thiele verfasserin aut Mohamed Abdel-Wahab verfasserin aut Matthias Gutberlet verfasserin aut In Journal of Clinical Medicine MDPI AG, 2013 9(2020), 6, p 1623 (DE-627)718632478 (DE-600)2662592-1 20770383 nnns volume:9 year:2020 number:6, p 1623 https://doi.org/10.3390/jcm9061623 kostenfrei https://doaj.org/article/ca9d3ab4519a4565b8efc1e2d76bcad3 kostenfrei https://www.mdpi.com/2077-0383/9/6/1623 kostenfrei https://doaj.org/toc/2077-0383 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2020 6, p 1623
allfieldsSound	10.3390/jcm9061623 doi (DE-627)DOAJ006441157 (DE-599)DOAJca9d3ab4519a4565b8efc1e2d76bcad3 DE-627 ger DE-627 rakwb eng Robin F. Gohmann verfasserin aut Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy Medicine R Philipp Lauten verfasserin aut Patrick Seitz verfasserin aut Christian Krieghoff verfasserin aut Christian Lücke verfasserin aut Sebastian Gottschling verfasserin aut Meinhard Mende verfasserin aut Stefan Weiß verfasserin aut Johannes Wilde verfasserin aut Philipp Kiefer verfasserin aut Thilo Noack verfasserin aut Steffen Desch verfasserin aut David Holzhey verfasserin aut Michael A. Borger verfasserin aut Holger Thiele verfasserin aut Mohamed Abdel-Wahab verfasserin aut Matthias Gutberlet verfasserin aut In Journal of Clinical Medicine MDPI AG, 2013 9(2020), 6, p 1623 (DE-627)718632478 (DE-600)2662592-1 20770383 nnns volume:9 year:2020 number:6, p 1623 https://doi.org/10.3390/jcm9061623 kostenfrei https://doaj.org/article/ca9d3ab4519a4565b8efc1e2d76bcad3 kostenfrei https://www.mdpi.com/2077-0383/9/6/1623 kostenfrei https://doaj.org/toc/2077-0383 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2020 6, p 1623
language	English
source	In Journal of Clinical Medicine 9(2020), 6, p 1623 volume:9 year:2020 number:6, p 1623
sourceStr	In Journal of Clinical Medicine 9(2020), 6, p 1623 volume:9 year:2020 number:6, p 1623
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy Medicine R
isfreeaccess_bool	true
container_title	Journal of Clinical Medicine
authorswithroles_txt_mv	Robin F. Gohmann @@aut@@ Philipp Lauten @@aut@@ Patrick Seitz @@aut@@ Christian Krieghoff @@aut@@ Christian Lücke @@aut@@ Sebastian Gottschling @@aut@@ Meinhard Mende @@aut@@ Stefan Weiß @@aut@@ Johannes Wilde @@aut@@ Philipp Kiefer @@aut@@ Thilo Noack @@aut@@ Steffen Desch @@aut@@ David Holzhey @@aut@@ Michael A. Borger @@aut@@ Holger Thiele @@aut@@ Mohamed Abdel-Wahab @@aut@@ Matthias Gutberlet @@aut@@
publishDateDaySort_date	2020-01-01T00:00:00Z
hierarchy_top_id	718632478
id	DOAJ006441157
language_de	englisch
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Gohmann</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2020</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a"><b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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. 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author	Robin F. Gohmann
spellingShingle	Robin F. Gohmann misc aortic stenosis misc computed tomography coronary angiography misc coronary angiography misc coronary artery disease misc transcatheter aortic valve implantation misc diagnostic accuracy misc Medicine misc R Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease
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topic_title	Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease aortic stenosis computed tomography coronary angiography coronary angiography coronary artery disease transcatheter aortic valve implantation diagnostic accuracy
topic	misc aortic stenosis misc computed tomography coronary angiography misc coronary angiography misc coronary artery disease misc transcatheter aortic valve implantation misc diagnostic accuracy misc Medicine misc R
topic_unstemmed	misc aortic stenosis misc computed tomography coronary angiography misc coronary angiography misc coronary artery disease misc transcatheter aortic valve implantation misc diagnostic accuracy misc Medicine misc R
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title	Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease
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title_full	Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease
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author_browse	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
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author-letter	Robin F. Gohmann
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title_sort	combined coronary ct-angiography and tavi-planning: a contrast-neutral routine approach for ruling-out significant coronary artery disease
title_auth	Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease
abstract	<b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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.
abstractGer	<b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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.
abstract_unstemmed	<b<Background</b<: 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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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.
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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. <b<Methods</b<: 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<sup<+</sup<). 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. <b<Results</b<: 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<sup<+</sup<-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. <b<Conclusion</b<: 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.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">aortic stenosis</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">computed tomography coronary angiography</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">coronary angiography</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">coronary artery disease</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">transcatheter aortic valve implantation</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">diagnostic accuracy</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">R</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Philipp Lauten</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Patrick Seitz</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Christian Krieghoff</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Christian Lücke</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Sebastian Gottschling</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Meinhard Mende</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Stefan Weiß</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Johannes Wilde</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Philipp Kiefer</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Thilo Noack</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Steffen Desch</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">David Holzhey</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Michael A. 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Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease

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