Abstract：
Computed tomography angiography (CTA) is a cornerstone in the pre- transcatheter aortic valve replacement (TAVI) assessment. We evaluated the diagnostic performance of CTA and coronary artery calcium score (CACS) for CAD evaluation compared to invasive coronary angiography in a cohort of TAVI patients.
In consecutive TAVI patients without prior coronary revascularization and device implants, CAD was assessment by quantitative analysis in CTA. (a) Patients with non-evaluable segments were classified as obstructive CAD. (b) In patients with non-evaluable segments a CACS cut-off of 100 was applied for obstructive CAD. The reference standard was quantitative invasive coronary angiography (QCA, i.e. ≥ 50% stenosis).
100 consecutive patients were retrospectively included, age was 82.3 ± 6.5 years and 30% of patients had CAD. In 16% of the patients, adequate visualization of the entire coronary tree (all 16 segments) was possible with CTA, while 84% had at least one segment which was not evaluable for CAD analysis due to impaired image quality. On a per-patient analysis, where patients with low image quality were classified as CAD, CTA showed a sensitivity of 100% (95% CI 88.4-100.0), specificity of 11.4% (95% CI 5.1-21.3), PPV of 32.6% (95% CI 30.8-34.5), NPV of 100% and diagnostic accuracy of 38% (95% CI 28.5-48.3) for obstructive CAD. When applying a combined approach of CTA (in patients with good image quality) and CACS (in patients with low image quality), the sensitivity and NPV remained at 100% and obstructive CAD could be ruled out in 20% of the TAVI patients, versus 8% using CTA alone.
In routinely acquired pre-TAVI CTA, the image quality was insufficient in a high proportion of patients for the assessment of the entire coronary artery tree. However, when adding CACS in patients with low image quality to quantitative CTA assessment in patients with good image quality, obstructive CAD could be ruled-out in 1/5 of the patients and may therefore constitute a strategy to streamline pre-procedural workup, and reduce risk, radiation and costs in selected TAVI patients without prior coronary revascularization or device implants.
In consecutive TAVI patients without prior coronary revascularization and device implants, CAD was assessment by quantitative analysis in CTA. (a) Patients with non-evaluable segments were classified as obstructive CAD. (b) In patients with non-evaluable segments a CACS cut-off of 100 was applied for obstructive CAD. The reference standard was quantitative invasive coronary angiography (QCA, i.e. ≥ 50% stenosis).
100 consecutive patients were retrospectively included, age was 82.3 ± 6.5 years and 30% of patients had CAD. In 16% of the patients, adequate visualization of the entire coronary tree (all 16 segments) was possible with CTA, while 84% had at least one segment which was not evaluable for CAD analysis due to impaired image quality. On a per-patient analysis, where patients with low image quality were classified as CAD, CTA showed a sensitivity of 100% (95% CI 88.4-100.0), specificity of 11.4% (95% CI 5.1-21.3), PPV of 32.6% (95% CI 30.8-34.5), NPV of 100% and diagnostic accuracy of 38% (95% CI 28.5-48.3) for obstructive CAD. When applying a combined approach of CTA (in patients with good image quality) and CACS (in patients with low image quality), the sensitivity and NPV remained at 100% and obstructive CAD could be ruled out in 20% of the TAVI patients, versus 8% using CTA alone.
In routinely acquired pre-TAVI CTA, the image quality was insufficient in a high proportion of patients for the assessment of the entire coronary artery tree. However, when adding CACS in patients with low image quality to quantitative CTA assessment in patients with good image quality, obstructive CAD could be ruled-out in 1/5 of the patients and may therefore constitute a strategy to streamline pre-procedural workup, and reduce risk, radiation and costs in selected TAVI patients without prior coronary revascularization or device implants.
摘要：
计算机断层扫描血管造影（CTA）是经导管主动脉瓣置换术（TAVI）前评估的基石。我们在一组TAVI患者中评估了CTA和冠状动脉钙积分（CACS）用于CAD评估的诊断性能，与侵入性冠状动脉造影相比。
在没有冠状动脉血运重建和植入装置的连续TAVI患者中，通过CTA定量分析评估CAD。(a)具有不可评价节段的患者被分类为阻塞性CAD。（b）在具有不可评估节段的患者中，阻塞性CAD的CACS截止值为100。参考标准是定量有创冠状动脉造影（QCA，即≥50%狭窄)。
回顾性纳入100例连续患者，年龄为82.3±6.5岁,30%的患者患有CAD.在16%的患者中，使用CTA可以充分可视化整个冠状动脉树（所有16个节段），而84%的患者有至少一个节段由于图像质量受损而无法进行CAD分析。在每个患者的分析中，图像质量低的患者被归类为CAD，CTA的敏感性为100%（95%CI88.4-100.0），特异性为11.4%（95%CI5.1-21.3），PPV为32.6%（95%CI30.8-34.5），阻塞性CAD的NPV为100％，诊断准确率为38％（95％CI28.5-48.3）。当应用CTA（图像质量好的患者）和CACS（图像质量低的患者）的组合方法时，敏感性和NPV保持在100%，20%的TAVI患者可以排除阻塞性CAD，与单独使用CTA的8%相比。
在常规获得的TAVI前CTA中，大部分患者的图像质量不足以评估整个冠状动脉树.然而,将低图像质量患者的CACS添加到高图像质量患者的定量CTA评估中,1/5的患者可以排除梗阻性CAD，因此可以构成简化术前检查的策略，降低风险,未进行冠状动脉血运重建或植入装置的选定TAVI患者的辐射和费用。
在没有冠状动脉血运重建和植入装置的连续TAVI患者中，通过CTA定量分析评估CAD。(a)具有不可评价节段的患者被分类为阻塞性CAD。（b）在具有不可评估节段的患者中，阻塞性CAD的CACS截止值为100。参考标准是定量有创冠状动脉造影（QCA，即≥50%狭窄)。
回顾性纳入100例连续患者，年龄为82.3±6.5岁,30%的患者患有CAD.在16%的患者中，使用CTA可以充分可视化整个冠状动脉树（所有16个节段），而84%的患者有至少一个节段由于图像质量受损而无法进行CAD分析。在每个患者的分析中，图像质量低的患者被归类为CAD，CTA的敏感性为100%（95%CI88.4-100.0），特异性为11.4%（95%CI5.1-21.3），PPV为32.6%（95%CI30.8-34.5），阻塞性CAD的NPV为100％，诊断准确率为38％（95％CI28.5-48.3）。当应用CTA（图像质量好的患者）和CACS（图像质量低的患者）的组合方法时，敏感性和NPV保持在100%，20%的TAVI患者可以排除阻塞性CAD，与单独使用CTA的8%相比。
在常规获得的TAVI前CTA中，大部分患者的图像质量不足以评估整个冠状动脉树.然而,将低图像质量患者的CACS添加到高图像质量患者的定量CTA评估中,1/5的患者可以排除梗阻性CAD，因此可以构成简化术前检查的策略，降低风险,未进行冠状动脉血运重建或植入装置的选定TAVI患者的辐射和费用。
