High-pitch dual-source aortoiliac CTA: systolic data acquisition for measuring Aortic Annulus Dimensions before TAVR; comparison with multiphasic retrospectively ECG-triggered cardiac CTA

Zielsetzung:

To evaluate feasibility of a systolic high-pitch aortoiliac Dual-Source CTA (DSCTA) examination for measuring Aortic Annulus Dimensions before transcatheter aortic valve replacement (TAVR) as compared with multiphasic retrospectively ECG-triggered cardiac CTA.

Material und Methodik:

Twenty-one consecutive patients with severe aortic stenosis (9 women, mean age 83 ± 6 years) underwent pre-TAVR combined single dose contrast-enhanced multiphasic retrospective ECG-gated cardiac and ECG-gated high-pitch aortoiliac DSCTA with cardiac data acquisition initiated at 10% of the R-R-interval. Heart rate (HR) and heart rate variability (HRV) were assessed during the Flash ECG prediction phase. Aortic annulus dimensions were planimetrically quantified as area-derived diameter (DA). Hypothetical prosthesis sizing was based on DA (23-mm prosthesis: < 22mm; 26-mm: 22–25mm; 29-mm: >25 mm) and compared between maximum DA from the multiphasic dataset and DA from the systolic high-pitch acquisition.

Ergebnisse:

Aortic root dimensions were analyzable in all 21 patients. Atrial fibrillation was present in 6 patients (mean HR/HRV [bpm]: 77.1 ± 9.1; 13.7 ± 5.2) which lead to aortic root high-pitch data acquisition during diastole in three patients (64%, 78% und 91%) With sizing by systolic high pitch DA nominal prosthesis diameter was smaller in 1 of 6 patients. Of the 14 patients with sinus rhythm (mean HR/HRV [bpm]: 71.9 ± 12.7, 4 ± 6.1) two patients showed HR>90 bpm (HRV < 1.2), which lead to diastolic data acquisition (67%) and prosthesis mismatch in one patient.

Schlussfolgerungen:

For patients with sinus rhythm and an average heart rate below 90 bpm systolic high-pitch aortoiliac DSCTA allows for adequate prosthesis sizing for TAVR as compared to multiphasic retrospectively ECG-triggered cardiac CTA.

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