title: Clinical and economic consequences of non-cardiac incidental findings detected on cardiovascular computed tomography performed prior to transcatheter aortic valve implantation (TAVI).
abstract: Transcatheter aortic valve implantation (TAVI) is an effective treatment option for patients with severe degenerative aortic valve stenosis who are high risk for conventional surgery. Computed tomography (CT) performed prior to TAVI can detect pathologies that could influence outcomes following the procedure, however the incidence, cost, and clinical impact of incidental findings has not previously been investigated. 279 patients underwent CT; 188 subsequently had TAVI and 91 were declined. Incidental findings were classified as clinically significant (requiring treatment), indeterminate (requiring further assessment), or clinically insignificant. The primary outcome measure was all-cause mortality up to 3 years. Costs incurred by additional investigations resultant to incidental findings were estimated using the UK Department of Health Payment Tariff. Incidental findings were common in both the TAVI and medical therapy cohorts (54.8 vs. 70.3%; P = 0.014). Subsequently, 45 extra investigations were recommended for the TAVI cohort, at an overall average cost of £32.69 per TAVI patient. In a univariate model, survival was significantly associated with the presence of a clinically significant or indeterminate finding (HR 1.61; P = 0.021). However, on multivariate analysis outcomes after TAVI were not influenced by any category of incidental finding. Incidental findings are common on CT scans performed prior to TAVI. However, the total cost involved in investigating these findings is low, and incidental findings do not independently identify patients with poorer outcomes after TAVI. The discovery of an incidental finding on CT should not necessarily influence or delay the decision to perform TAVI.
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. alistair.lindsay@btinternet.com.
authors.forename: Alistair C
authors.initials: AC
authors.lastname: Lindsay
authors.affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Mona
authors.initials: M
authors.lastname: Sriharan
authors.affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Olga
authors.initials: O
authors.lastname: Lazoura
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Arunashis
authors.initials: A
authors.lastname: Sau
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Roughton
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jabbour
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Davies
authors.affiliation: Department of Surgery, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Moat
authors.affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Simon P G
authors.initials: SP
authors.lastname: Padley
authors.affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rubens
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Nicol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000191:economics / Q000401:mortality / Q000628:therapy; D006328:Cardiac Catheterization / Q000379:methods*; D002423:Cause of Death; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D033162:Incidental Findings; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D018803:Models, Economic; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*
keywords: CT; Cost-effectiveness; Incidental; TAVI