Imaging Pandora's Box: Incidental Findings in Elderly Patients Evaluated for Transcatheter Aortic Valve Replacement
| Autor: | Phillip M. Young, Charanjit S. Rihal, Paul Sorajja, Thomas C. Wright, Nicholas M. Orme, Kevin L. Greason, Rakesh M. Suri, Thomas A. Foley, Vuyisile T. Nkomo, Eric E. Williamson, Gil E. Harmon |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Malignancy Asymptomatic Valve replacement Preoperative Care medicine Humans Survival analysis Aged Aged 80 and over Heart Valve Prosthesis Implantation Incidental Findings Ejection fraction medicine.diagnostic_test business.industry Hazard ratio Angiography Aortic Valve Stenosis General Medicine medicine.disease Survival Analysis Surgery Stenosis Aortic Valve Female Radiology medicine.symptom Tomography X-Ray Computed business |
| Zdroj: | Mayo Clinic Proceedings. 89:747-753 |
| ISSN: | 0025-6196 |
| DOI: | 10.1016/j.mayocp.2014.03.011 |
| Popis: | Objective To determine the frequency and clinical impact of noncardiovascular incidental findings (IFs) detected on preoperative computed tomographic angiography (CTA) of the chest/abdomen/pelvis performed in elderly patients with severe aortic stenosis being considered for transcatheter aortic valve replacement (TAVR). Patients and Methods The CTA studies for 424 consecutive patients being evaluated for TAVR between January 1, 2009, through January 24, 2012, were reviewed for noncardiovascular IFs (62.0% male; median ± SD age, 82±8.3 years). The electronic medical record was reviewed to assess for subsequent clinical management and survival. Results Potentially pathologic IFs (PPIFs) were present in 285 patients (67.2%). The mean ± SD number of PPIFs per patient was 1.1±1.0 (range, 0-4). Factors associated with higher numbers of PPIFs were reduced ejection fraction ( P =.02) and history of smoking ( P =.06). Potentially pathologic incidental findings prompted clinical work-up in 39 patients (9.2%) and delayed or canceled treatment plans for aortic stenosis in 7 patients (1.7%). The number needed to image to diagnose a new malignancy or medical condition was 19. The number of PPIFs was predictive of poor overall survival before (hazard ratio, 1.58; 95% CI, 1.31-1.88) and after (hazard ratio, 1.45; 95% CI, 1.19-1.76) adjustment for baseline clinical variables ( P Conclusion This investigation found that PPIFs are common in elderly patients undergoing TAVR-CTA scans and, once discovered, commonly generate further clinical evaluation. Higher numbers of PPIFs may be predictive of poorer survival, but further study is required to guide the appropriateness of pursuing diagnostic evaluations for asymptomatic PPIFs in this elderly population. |
| Databáze: | OpenAIRE |
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