novel low-dose contrast cardiac ct angiography for aortic valve anulus sizing in transcatheter...

Non Invasive Imaging A1210 JACC April 1, 2014 Volume 63, Issue 12 NOVEL LOW-DOSE CONTRAST CARDIAC CT ANGIOGRAPHY FOR AORTIC VALVE ANULUS SIZING IN TRANSCATHETER AORTIC VALVE REPLACEMENT Poster Contributions Hall C Sunday, March 30, 2014, 3:45 p.m.-4:30 p.m. Session Title: Non-Coronary Cardiac CT Abstract Category: 18. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1212-65 Authors: Molly C. Mack, Deepika Gopalakrishnan, Paul Grayburn, Alicia Avila, Marina Lovil, Isabel Chacon, James M. Rampoldi, A. Cecile Mahoney, Jill Fowler, Angela Riley, William T. Brinkman, David L. Brown, Michael J. Mack, Ambarish Gopal, The Heart Hospital Baylor Plano, Plano, TX, USA, Cardiopulmonary Research Science and Technology Institute, Dallas, TX, USA Background: Cardiac CT angiography (CCTA) is currently the “gold standard” for accurately sizing the aortic valve annulus prior to transcatheter aortic valve replacement (TAVR). Signal-to-noise ratio (SNR) represents final image quality. A reduction of contrast volume without sacrificing image quality is desirable. Methods: 40 patients with severe aortic stenosis (age 83+8 years; 53% females) referred to CCTA for aortic valve annulus sizing were retrospectively analyzed. 20 patients underwent a low-dose contrast study (LDCT) and 20 patients underwent a traditional-dose study (TDCT). In the LDCT group, contrast dose chosen was <50% of the maximal allowable dose (calculated using 3.7 x eGFR). Guided by a time-density curve, the contrast was administered in a 2-stage infusion, and retrospectively-gated images were acquired with a 64-multidetector CT scanner and analyzed. Results: The amount of contrast was significantly lower in the LDCT group vs. the TDCT group (47+3 ml vs. 73+6 ml, p<0.0001). The SNR of the aortic root was 11+3 for LDCT group vs. 10+4 for TDCT group, p=0.19. A Bland-Altman plot compares both methods (Figure). LDCT yielded comparable clinical imaging quality of the aortic annulus to TDCT with 11 of the patients undergoing successful TAVR. Conclusion: LDCT can effectively assess the aortic valve annulus and direct the TAVR valve selection by providing accurate annulus sizing and adequate pre-procedural risk-stratification without subjecting patients to increased contrast dose.

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Page 1: NOVEL LOW-DOSE CONTRAST CARDIAC CT ANGIOGRAPHY FOR AORTIC VALVE ANULUS SIZING IN TRANSCATHETER AORTIC VALVE REPLACEMENT

Non Invasive Imaging

A1210JACC April 1, 2014

Volume 63, Issue 12

novel low-dose conTrasT cardiac cT angiography for aorTic valve anUlUs sizing in TranscaTheTer aorTic valve replaceMenT

Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.

Session Title: Non-Coronary Cardiac CTAbstract Category: 18. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT AngiographyPresentation Number: 1212-65

Authors: Molly C. Mack, Deepika Gopalakrishnan, Paul Grayburn, Alicia Avila, Marina Lovil, Isabel Chacon, James M. Rampoldi, A. Cecile Mahoney, Jill Fowler, Angela Riley, William T. Brinkman, David L. Brown, Michael J. Mack, Ambarish Gopal, The Heart Hospital Baylor Plano, Plano, TX, USA, Cardiopulmonary Research Science and Technology Institute, Dallas, TX, USA

Background: Cardiac CT angiography (CCTA) is currently the “gold standard” for accurately sizing the aortic valve annulus prior to transcatheter aortic valve replacement (TAVR). Signal-to-noise ratio (SNR) represents final image quality. A reduction of contrast volume without sacrificing image quality is desirable.

Methods: 40 patients with severe aortic stenosis (age 83+8 years; 53% females) referred to CCTA for aortic valve annulus sizing were retrospectively analyzed. 20 patients underwent a low-dose contrast study (LDCT) and 20 patients underwent a traditional-dose study (TDCT). In the LDCT group, contrast dose chosen was <50% of the maximal allowable dose (calculated using 3.7 x eGFR). Guided by a time-density curve, the contrast was administered in a 2-stage infusion, and retrospectively-gated images were acquired with a 64-multidetector CT scanner and analyzed.

results: The amount of contrast was significantly lower in the LDCT group vs. the TDCT group (47+3 ml vs. 73+6 ml, p<0.0001). The SNR of the aortic root was 11+3 for LDCT group vs. 10+4 for TDCT group, p=0.19. A Bland-Altman plot compares both methods (Figure). LDCT yielded comparable clinical imaging quality of the aortic annulus to TDCT with 11 of the patients undergoing successful TAVR.

conclusion: LDCT can effectively assess the aortic valve annulus and direct the TAVR valve selection by providing accurate annulus sizing and adequate pre-procedural risk-stratification without subjecting patients to increased contrast dose.

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