SPC365

Accuracy of computed tomography angiography for the exclusion of coronary artery disease before transcatheter aortic valve implantation

Session: SESSÃO DE POSTERS 39 - IMAGEM CARDÍACA NA ESTENOSE AÓRTICA
Speaker: Vanessa Lopes

Congress: CPC 2025
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.2 Computed Tomography
Session Type: Cartazes
FP Number: ---
Authors: Vanessa Lopes; Pedro Almeida; Rafaela Fernandes; Gil Cunha; Nádia Moreira; Ana Ramalho; Rogério Teixeira; Lino Gonçalves

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Evaluation for coronary artery disease (CAD) is recommended before transcatheter aortic valve replacement (TAVR). In most cases, this is done with invasive coronary angiography (ICA). Current practice guidelines recommend screening to rule out significant proximal lesions. Computed tomography angiography (CTA) is currently used in the preprocedure planning of TAVR.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">This study sought to investigate the efficacy of CTA imaging in assessing the proximal&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">coronary arteries, and the feasibility of its use as a screening tool for significant CAD before TAVR.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">We retrospectively analyzed <span style="color:black">patients referred for TAVR in a </span>single center. Patients <span style="color:black">with a preprocedure CTA, preprocedure ICA, and without prior proximal percutaneous intervention (PCI) were included in the study. Patients with poor CTA image quality precluding interpretation were excluded.</span> The <span style="color:black">proximal segment of the coronary arteries</span> was analyzed by CTA to assess for nonsignificant stenosis (0% to 49%), moderate stenosis (50% to 69%), and severe stenosis (&ge;70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR), negative LR, and Cohen Kappa statistic were analyzed.</span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">A total of 126 patients were included in the analysis: median age was 82 years (IQR 7), and 48% (n=60) of patients were male. The overall prevalence of significant proximal CAD was 9.5%. CTA evaluation revealed a sensitivity of 75%, specificity of 96%, PPV of 24%, NPV of 100%, positive LR of 19.0 (95% CI 10.5-24.4), and negative LR of 0.26 (95% CI 0.08-0.86) for detecting &ge;50% stenosis (Table 1). Using a &ge;70% stenosis cutoff, the evaluation revealed a sensitivity of 80%, specificity of 99%, PPV of 51%, NPV of 100%, positive LR of 128.8 (95% CI 38.4-432.0), and negative LR of 0.20 (95% CI 0.03-1.16) (Table 2). Cohen Kappa analysis indicated a fair agreement between pre-TAVR CTA and ICA (Cohen k-test 0.35, p &lt;0.001). </span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Pre-TAVR CTA is a useful tool in the screening for significant proximal CAD before TAVR and, due to its high negative predictive value, could spare patients the need for additional invasive testing before the procedure.</span></span></span></p>

Our mission: To reduce the burden of cardiovascular disease
Visit our site

LISBOA
Campo Grande 28 - 13º |
1700-093 Lisboa
(+351) 21 797 06 85
(+351) 21 781 76 30
secretariado@spc.pt

COIMBRA
Rua de Olivença 11 - 7º Piso,
Sala 701, 3000-306 Coimbra
(+351) 239 83 81 01
(+351) 239 83 81 02
(+351) 239 83 81 03
cncdc@spc.pt

PORTO
Rua do Campo Alegre
803, Sala 8, 4150 Porto
(+351) 22 606 07 44
delegacao-norte@spc.pt