Predictors of diagnostic inaccuracy of coronary artery stenosis by preprocedural CT angiography in patients prior to transcatheter aortic valve implantation

Matthias Renker (Bad Nauheim)1, S. Kriechbaum (Bad Nauheim)1, E. I. Charitos (Bad Nauheim)2, T. Seidler (Bad Nauheim)1, Y.-H. Choi (Bad Nauheim)3, A. Rolf (Bad Nauheim)1, W.-K. Kim (Bad Nauheim)1, S. T. Sossalla (Gießen)4

1Kerckhoff Klinik GmbH Abteilung für Kardiologie Bad Nauheim, Deutschland; 2Kerckhoff Klinik GmbH Bad Nauheim, Deutschland; 3Kerckhoff Klinik GmbH Herzchirurgie Bad Nauheim, Deutschland; 4Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland


Introduction: The diagnostic performance of preprocedural CT angiography in detecting coronary artery disease (CAD) in patients scheduled for transcatheter aortic valve implantation (TAVI) has been reported. However, data on predictors of diagnostic inaccuracy are sparse. Therefore, the present study sought to investigate clinical characteristics and imaging criteria that predict inaccurate assessment of coronary artery stenosis based on TAVI-CT. 

Methods: The clinical characteristics and CT datasets of 192 patients (mean age 82.1±4.8 years; 63.5% female) without known CAD or severe renal dysfunction were analysed retrospectively. Significant CAD was defined as CAD-RADS ≥4 by CT. Invasive coronary angiography served as the reference standard, defined as >70% stenosis or fractional flow reserve <0.80). Prespecified patient criteria as well as CT imaging parameters of all true-positive (n=71), false-positive (n=30), false-negative (n=4) and true-negative diagnoses (n=87) for relevant stenosis according to the invasive reference standard were assessed in a blinded manner. 

Results: In univariate analyses, the following parameters yielded discriminative power (p<0.20) regarding inaccurate CAD assessment per patient by TAVI-CT: age, body mass index, arterial hypertension, atrial fibrillation, heart rate during CT examination, and subjective CT image quality rating. Factors independently associated with CT diagnostic inaccuracies were determined using multivariable logistic regression analysis: younger age (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.81 to 0.96), CT system not capable of single-heartbeat acquisition (OR 0.27; CI 0,11 to 0,70), and insufficient CT image quality (OR 4,26; CI 1,47 to 12,35).

Conclusions: Our results demonstrate clinical characteristics and CT imaging criteria that predict inaccurate coronary artery assessment by TAVI-CT in comparison with the invasive reference standard. Knowledge of these predictors may aid in coronary artery interpretation based on CT prior to TAVI.

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