title: Feasibility and accuracy of a comprehensive multidetector computed tomography acquisition for patients referred for balloon-expandable transcatheter aortic valve implantation.
abstract: BACKGROUND
  The aim of this study was to assess the accuracy of a comprehensive multidetector computed tomography (MDCT) evaluation of the aortic annulus (AoA), coronary artery disease (CAD), and peripheral vessels in patients referred for transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  In 60 patients referred for TAVI, the following parameters were assessed with 64-slices MDCT and compared with transesophageal echocardiography (TEE), invasive coronary angiography (ICA), and peripheral angiography: AoA maximum diameter (Max-AoA-D(MDCT)), minimum diameter (Min-AoA-D(MDCT)), and area; lumen morphology index ([Max-AoA-D(MDCT)/Min-AoA-D(MDCT)]); length of the left, right, and non-coronary aortic leaflets; degree (grades 1-4) of aortic leaflet calcifications; distance between AoA and left main coronary ostium and between AoA and right coronary ostium CAD and peripheral vessel disease.
  
  
  RESULTS
  The Max-AoA-D(MDCT) and Min-AoA-D(MDCT) were 25.1 ± 2.8 and 21.2 ± 2.2 mm, respectively, with high correlation versus AoA diameter measured with TEE (r = 0.82 and 0.86, respectively). The area of AoA, systolic and diastolic lumen morphology index were 410 ± 81.5 mm(2), 1.19 ± 0.1 and 1.22 ± 0.11, respectively. Aortic leaflet calcification score was 3.3 ± 0.5. The lengths of left, right, and non-coronary aortic leaflets were 14.2 ± 2.4, 13.7.1 ± 2.1, and 14.5 ± 2.6 mm, whereas distances between AoA and the left main coronary ostium and between AoA, and the right coronary ostium were 13.7 ± 2.9 and 15.8 ± 3.5 mm, respectively. Feasibility, negative predictive value, and accuracy for CAD detection versus ICA were 87%, 100% (CI 100-100), and 96% (95% CI 94-100), respectively. All patients (N = 17) who were ineligible for TAVI were correctly detected by MDCT.
  
  
  CONCLUSIONS
  A comprehensive MDCT evaluation of patients referred for TAVI is feasible, provides more accurate assessment than TEE of AoA morphology, and may replace peripheral angiography in all patients and ICA in patients without significant CAD.
authors.affiliation: Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. gianluca.pontone@ccfm.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Annoni
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.forename: Erika
authors.initials: E
authors.lastname: Bertella
authors.forename: Alberto
authors.initials: A
authors.lastname: Formenti
authors.forename: Sarah
authors.initials: S
authors.lastname: Cortinovis
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.forename: Melissa
authors.initials: M
authors.lastname: Fusari
authors.forename: Veronica
authors.initials: V
authors.lastname: Bona
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ballerini
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000033:anatomy & histology*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000033:anatomy & histology; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D017755:Prosthesis Fitting; D014057:Tomography, X-Ray Computed / Q000379:methods*