Invasive Coronary Angiography in Patients with Native or Prosthetic Aortic-Valve Endocarditis – Outcomes and Implications for Myocardial Revascularisation

2021 ◽  
Author(s):  
Tim Berger ◽  
Matthias Siepe ◽  
Dominik Dees ◽  
Clarence Pingpoh ◽  
Stoyan Kondov ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Prosthetic Aortic Valve ◽  
Myocardial Revascularisation

Abstract 14527: Utility of Routine Invasive Coronary Angiography Prior to Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian C Case ◽  
Charan Yerasi ◽  
Brian J Forrestal ◽  
Anees Musallam ◽  
Chava Chezar Azerrad ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Coronary Angiography ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Invasive Coronary Angiography ◽  
Heart Team ◽  
Artery Disease ◽  
Ischemia Testing

Introduction: Despite the high prevalence of CAD in patients with severe aortic stenosis (AS), the optimal management of concomitant coronary artery disease (CAD) before trasncatheter aortic valve replacement (TAVR) remains controversial. Hypothesis: To characterize the contemporary, real-world burden of CAD in contemporary TAVR patients and to evaluate revascularization practices at a high-volume center in the United States. Methods: Analysis of all adult patients referred for TAVR at our center between January 2019 and January 2020. Presence of significant coronary artery disease (stenosis >50%) and subsequent management (medical therapy versus revascularization) were recorded. Presenting symptoms, use of non-invasive and invasive ischemia testing and pre-TAVR computed tomography (CT) imaging were all analyzed. Results: A total of 394 patients with severe AS were referred to our institution for TAVR. Thirty-nine patients (9.9%) instead underwent surgical aortic valve replacement (SAVR), of which only 5 (1.3%) underwent SAVR plus coronary artery bypass surgery. Of the remaining 355 patients (77.3 ± 9.3 years old and 59.7% males), 218 patients (61.4%) had insignificant CAD. Of the 137 patients (38.6%) with significant CAD, only 30 (8.5%) underwent percutaneous coronary intervention (PCI). Of these, less than half had anginal symptoms, a third had CAD in proximal segments and a third underwent ischemia testing prior to PCI. Pre-TAVR CT accurately identified significant CAD in 28/30 patients (93.3%) who ultimately underwent PCI. Conclusions: Only 1 in 25 contemporary TAVR patients had significant CAD and anginal symptoms requiring intervention, questioning the utility of routine invasive coronary angiography before TAVR. A Heart Team approach integrating anginal symptoms and ischemia testing is needed to guide the need, timing and strategy of revascularization. The pre-TAVR CT images could identify significant proximal segment CAD needing PCI.

Diagnostic Performance of Quantitative Coronary Artery Disease Assessment Using Computed Tomography in Patients with Aortic Stenosis Undergoing Transcatheter Aortic-Valve Implantation

2021 ◽  
Author(s):  
Daniel Malebranche ◽  
Maximilian K.M. Hoffner ◽  
Adrian T. Huber ◽  
Aleksandar Cicovic ◽  
Giancarlo Spano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Coronary Angiography ◽  
Diagnostic Performance ◽  
Invasive Coronary Angiography ◽  
Calcium Score ◽  
Disease Assessment ◽  
Transcatheter Aortic Valve ◽  
Artery Disease

Abstract Purpose: Computed tomography angiography (CTA) is a cornerstone in the pre- transcatheter aortic valve replacement (TAVI) assessment. We evaluated the diagnostic performance of CTA and coronary artery calcium score (CACS) for CAD evaluation compared to invasive coronary angiography in a cohort of TAVI patients. Methods: In consecutive TAVI patients, CAD was assessment by quantitative analysis in CTA. a) Patients with non-evaluable segments were classified as obstructive CAD. b) In patients with non-evaluable segments a CACS cut-off of 100 was applied for obstructive CAD. The reference standard was quantitative invasive coronary angiography (QCA,i.e.≥50% stenosis). Results: 100 consecutive patients were retrospectively included, age was 82.3±6.5years and 30% of patients had CAD. On a per-patient analysis CTA showed a sensitivity of 100% (95%CI: 88.4-100.0), specificity of 11.4% (95%CI: 5.1-21.3), PPV of 32.6% (95%CI: 30.8-34.5), NPV of 100% and diagnostic accuracy of 38% (95%CI: 28.5-48.3) for obstructive CAD. When applying a combined CTA/CACS approach, the sensitivity and NPV remained at 100% and obstructive CAD could be ruled out in 20% of the TAVI patients, versus 8% using CTA alone. Conclusion: Quantitative combined CTA/CACS assessment from routinely acquired pre-TAVI investigation showed good diagnostic performance to rule-out obstructive CAD and may constitute a valuable strategy to streamline diagnostic workup in selected patients undergoing TAVI.

Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

2005 ◽  
Vol 8 (1) ◽  
pp. 42 ◽  
Author(s):  
C. Probst ◽  
A. Kovacs ◽  
C. Schmitz ◽  
W. Schiller ◽  
H. Schild ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Invasive Coronary Angiography ◽  
Bypass Graft ◽  
Heart Association ◽  
Artery Stenosis ◽  
Vessel Disease ◽  
Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

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