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. 2023 May 1;38(3):165-173.
doi: 10.1097/RTI.0000000000000699. Epub 2023 Apr 1.

Comparison of First-generation and Third-generation Dual-source Computed Tomography for Detecting Coronary Artery Disease in Patients Evaluated for Transcatheter Aortic Valve Replacement

Matthias Renker  1   2   3 , Robert Steinbach  1 , U Joseph Schoepf  4 , Ulrich Fischer-Rasokat  1 , Yeong-Hoon Choi  2   3 , Christian W Hamm  1   3   4 , Andreas Rolf  1   3   4 , Won-Keun Kim  1   2   3   4
Affiliations

Comparison of First-generation and Third-generation Dual-source Computed Tomography for Detecting Coronary Artery Disease in Patients Evaluated for Transcatheter Aortic Valve Replacement

Matthias Renker et al. J Thorac Imaging. .

Abstract

Purpose: This study compared image quality and evaluability of coronary artery disease (CAD) in routine preparatory imaging for transcatheter aortic valve replacement using 64-slice (first-generation) to 192-slice (third-generation) dual-source computed tomography(DSCT).

Materials and methods: The CT data sets of 192 patients (122 women, median age 82 y) without severe renal dysfunction or known CAD were analyzed retrospectively. Half were examined using first-generation DSCT (June 2014 to February 2016) and the other half with third-generation DSCT (April 2016 to April 2017). Per protocol, contrast material (110 [110 to 120] vs. 70 [70 to 70] mL, P <0.001) and radiation dose of multiphasic retrospectively gated thoracic CT angiography (dose-length-product, 1001 [707 to 1312] vs. 727 [474 to 1369] mGy×cm, P <0.001) were significantly lower with third-generation DSCT. Significant CAD was defined as CAD-RADS ≥4 by CT. Invasive coronary angiography served as the reference standard (CAD is defined as ≥70% stenosis or fractional flow reserve ≤0.80).

Results: In comparison with first-generation DSCT, third-generation DSCT showed significantly better subjective (3 [interquartile range 2 to 3] vs. 4 [3 to 4.25] on a 5-point scale, P <0.001) and objective image quality (signal-to-noise ratio of left coronary artery 12.8 [9.9 to 16.4] vs. 15.2 [12.4 to 19.0], P <0.001). Accuracy (72.9% vs. 91.7%, P =0.001), specificity (59.7% vs. 88.3%, P <0.001), positive (61.0% vs. 83.3%, P <0.001), and negative predictive value (91.9% vs. 98.2%, P =0.045) for detecting CAD per-patient were significantly better using third-generation DSCT, while sensitivity was similar (92.3% vs. 97.2%, P =0.129).

Conclusions: Coronary artery evaluation with CT angiography before TAVI is feasible in selected patients. Compared with first-generation DSCT, state-of-the-art third-generation DSCT technology is superior for this purpose, allowing for less contrast medium and radiation dose while providing better image quality and improved diagnostic performance.

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Conflict of interest statement

U.J.S.: grants and/or personal fees from Bayer, Bracco, Elucid BioImaging, GE, Guerbet, HeartFlow Inc., Keya Medical, and Siemens. C.W.H.: advisory board Medtronic. Y.H.C.: speaker honoraria: Edwards Lifescience, Cytosorbents, CryoLife, Getinge. W.K.K.: proctor/speaker fees from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Meril Life Sciences. The remaining authors declare no conflicts of interest.

References

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