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

Abstract

\n 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.