Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation
- 19 March 2016
- journal article
- cardiac
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 26 (12), 4497-4504
- https://doi.org/10.1007/s00330-016-4320-8
Abstract
Objectives Chronic renal failure is common in patients referred for transcatheter aortic valve implantation (TAVI). CT angiography is recommended and provides crucial information prior to TAVI. We evaluated the feasibility of a reduced contrast volume protocol for pre-procedural CT imaging. Methods Forty consecutive patients were examined with prospectively ECG-triggered high-pitch spiral acquisition using a novel third-generation dual-source CT system; 38 ml contrast agent was used. Image quality was graded on a visual scale (1–4). Contrast attenuation was measured at the level of the aortic root and at the iliac bifurcation. Results Mean patient age was 82 ± 6 years (23 males; 58 %). Mean attenuation/average image quality was 285 ± 60 HU/1.5 at the aortic annulus compared to 289 ± 74 HU/1.8 at the iliac bifurcation (p = 0.77/p = 0.29). Mean estimated effective radiation dose was 2.9 ± 0.3 mSv. A repeat acquisition was necessary in one patient due to image quality. Out of the 35 patients who underwent TAVI, 31 (89 %) patients had no or mild aortic regurgitation. Thirty-two (91 %) patients were discharged successfully. Conclusion Pre-procedural CTA with a total of 38 ml contrast volume is feasible and clinically useful, using third-generation dual-source CT, allowing comprehensive imaging for procedural success. Key points • Reduction of contrast agent volume is crucial in patients with chronic renal failure. • Novel third-generation computed tomography helps to reduce contrast agent volume. • Pre-procedural CT allows comprehensive imaging for procedural success before heart valve implantation. • A low-contrast CT protocol is feasible for pre-procedural TAVI planning.Funding Information
- Bundesministerium für Bildung und Forschung (01EX1012B)
This publication has 28 references indexed in Scilit:
- Closing in on the K Edge: Coronary CT Angiography at 100, 80, and 70 kV—Initial Comparison of a Second- versus a Third-Generation Dual-Source CT SystemRadiology, 2014
- Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studiesHeart, 2012
- Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve ReplacementThe New England Journal of Medicine, 2012
- Long-Term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis: The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) RegistryJournal of the American College of Cardiology, 2011
- Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposedJournal of Clinical Epidemiology, 2011
- Ultra-Low-Dose Intra-Arterial Contrast Injection for Iliofemoral Computed Tomographic AngiographyJACC: Cardiovascular Imaging, 2009
- The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiencyJournal of the American College of Cardiology, 2000
- Acute Renal Failure After Coronary Intervention: Incidence, Risk Factors, and Relationship to MortalityThe American Journal of Medicine, 1997
- Dosing of contrast material to prevent contrast nephropathy in patients with renal diseaseThe American Journal of Medicine, 1989
- Left retrograde cardioangiography in acquired cardiac disease: Technic, indications and interpretations in 700 cases∗The American Journal of Cardiology, 1964