title: Coronary CT angiography for the detection of coronary artery stenosis in patients referred for transcatheter aortic valve replacement.
abstract: BACKGROUND
  Coronary CT has become the foremost noninvasive imaging modality for detecting coronary stenoses in patients with suspected coronary artery disease. Nevertheless, little is known about its performance in patients undergoing transcatheter aortic valve replacement (TAVR).
  
  
  OBJECTIVE
  This study investigates the diagnostic performance of coronary CT angiography in patients referred for TAVR.
  
  
  METHODS
  One hundred and fifteen consecutive patients with severe aortic stenosis underwent CT angiography with retrospective electrocardiography triggered acquisition and an iterative reconstruction algorithm, of whom 23 (20%) had prior coronary artery bypass graft (CABG) surgery. Diagnostic accuracy of CT for detecting significant coronary stenosis (≥ 50% luminal diameter stenosis in segments ≥ 2 mm) in the left main, proximal, or middle segments of coronary arteries and bypass grafts was compared with that of invasive coronary angiography.
  
  
  RESULTS
  In the overall study population, the sensitivity, specificity, and positive and negative predictive value of CT angiography for the detection of coronary segment or bypass graft lesions were 96% (47 of 49), 73% (48 of 66), 72% (47 of 65), and 96% (48 of 50), respectively. The per-patient diagnostic yield of CT angiography was consistent among patients without prior CABG (93% [28 of 30], 73% [45 of 62], 62% [28 of 45], and 96% [45 of 47], respectively) and among patients with prior CABG (100% [19 of 19], 75% [3 of 4], 95% [19 of 20], and 100% [3 of 3], respectively).
  
  
  CONCLUSIONS
  Among patients referred for TAVR, coronary CT angiography with retrospective gating and iterative reconstruction may allow detection of significant stenosis in the proximal or middle segments of coronary arteries and could permit the evaluation of patients after bypass grafts.
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel. Electronic address: Ashraf.Hamdan@sheba.health.gov.il.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.affiliation: Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Wellnhofer
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Konen
authors.affiliation: Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel; Department of Cardiac Surgery, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Andrada
authors.affiliation: Department of Cardiac Surgery, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Barbash
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
mesh_terms: D000368:Aged; D055424:Cardiac-Gated Imaging Techniques; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: Coronary CT angiography; Diagnostic performance; TAVR