CT annulus sizing prior to transcatheter aortic valve replacement (TAVR): evaluation of free-breathing versus breath-holding acquisition.

Autor: Cour A; Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France., Burel J; Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France., Garnier M; Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France., Durand E; Department of Cardiology, CHU Rouen, 37 Boulevard Gambetta, F-76000, Rouen, France.; Normandie Univ, UNIROUEN INSERM U1096, F-76000, Rouen, France., Demeyere M; Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France., Dacher JN; Department of Radiology, Cardiac Imaging Unit, Rouen University Hospital, 37 Boulevard Gambetta, F-76000, Rouen, France. jean-nicolas.dacher@chu-rouen.fr.; Normandie Univ, UNIROUEN INSERM U1096, F-76000, Rouen, France. jean-nicolas.dacher@chu-rouen.fr.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2023 Dec; Vol. 33 (12), pp. 8521-8527. Date of Electronic Publication: 2023 Jul 20.
DOI: 10.1007/s00330-023-09913-5
Abstrakt: Objectives: To assess feasibility and accuracy of aortic annulus measurements using cardiac computed tomography angiography (CTA) performed during free-breathing prior to transcatheter aortic valve replacement (TAVR).
Materials and Methods: Sixty consecutive TAVR candidates underwent free-breathing wide-detector cardiac CTA, followed by a percutaneous valve replacement. For each, a theoretical valve size was suggested through CT measurements of the annulus, then compared to the size of the actual implanted transcatheter heart valve (THV). The procedural success and the 30-day outcomes were collected. Image quality of the annulus was also studied according to subjective and objective criteria. Data of a control group of 60 patients previously evaluated on breath-holding were also evaluated.
Results: A total of 120 patients (mean age, 83 years ± 7, 60 men) were evaluated. All CT acquisitions provided sufficient image quality allowing precise annulus measurements. Mean attenuation (p < 0.001) and image noise (p = 0.01) were higher in the free-breathing group, while image quality was comparable (p = 0.36). The agreement rate between CT-suggested valve size and THV implanted size was comparable, estimated at 87% (κ = 0.79, 95%CI 0.566, 0.908) on free-breathing vs. 82% (κ = 0.78, 95%CI 0.634, 0.904) on breath-holding. The procedure was successful for all patients without increase in 30-day mortality or adverse events.
Conclusions: Free-breathing cardiac CTA allows accurate aortic annulus measurements without compromising image quality or patients' outcome after TAVR. Elderly patients experiencing dyspnea, discomfort, or hearing loss that could prevent proper breath-holding should not be excluded from CT prior to TAVR.
Clinical Relevance Statement: To decrease elderly patients' discomfort, MDCT evaluation prior to transcatheter aortic valve replacement (TAVR) may be performed on quiet breathing with no significant impact on the outcome.
Key Points: • Adhering to CT breathing commands can be challenging for patients with dyspnea, hearing impairment, agitation, or pulmonary diseases. • Free-breathing cardiac CT may be an alternative to breath-holding for patients unable to follow the breathing commands. • Wide-detector CT acquisition on free-breathing does not impair annulus measurements and prosthesis sizing in patients scheduled for TAVR.
(© 2023. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
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