Accuracy of Single-dose Transcatheter Aortic Valve Replacement Planning CT Angiography for the Detection of Coronary Artery Disease

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary Artery Disease in TAVR candidates (n=599). Intervention: Single-dose TAVR planning CT angiography vs. Invasive coronary angiography (ICA). Primary outcome: Detection of patients with at least one vessel with stenosis of 50% or more (Sensitivity 97.6%, Specificity 84.3%).

Florian T. Gassert; Torkel B. Brismar; Raquel Themudo; Anders Svensson

doi:10.1097/rti.0000000000000824

February 7, 2025Journal of Thoracic Imaging

Accuracy of Single-dose Transcatheter Aortic Valve Replacement Planning CT Angiography for the Detection of Coronary Artery Disease

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Key result

Single-dose TAVR planning CT angiography accurately detected obstructive coronary artery disease, yielding a per-patient sensitivity of 97.6% and specificity of 84.3% compared to invasive angiography.

Why the study?

The study assessed the accuracy of broad-detector TAVR planning CT examinations using a single dose of contrast media to diagnose CAD.

Does single-dose TAVR planning CT angiography accurately detect obstructive coronary artery disease compared to invasive coronary angiography in TAVR candidates?

Study Design

Type

Cross-Sectional (n=599)

Structured PICO

Does single-dose TAVR planning CT angiography accurately detect obstructive coronary artery disease compared to invasive coronary angiography in TAVR candidates?

P

Population

599 consecutive TAVR candidates (mean age 78.6 years, 40.2% female) who underwent both single-dose TAVR planning CT and invasive coronary angiography.

E

Exposure

Single-dose TAVR planning CT angiography (320-detector row, single i.v. contrast media bolus of iodixanol)

C

Comparator

Invasive coronary angiography (ICA)

O

Outcome

Diagnostic accuracy (sensitivity, specificity, NPV, PPV) for detecting obstructive CAD (≥50% stenosis) on a per-patient and per-vessel basissurrogate

Main Result

Effect estimate: Sensitivity 97.6%, Specificity 84.3%

Single-dose TAVR planning CT angiography demonstrates high sensitivity and negative predictive value for excluding moderate-to-severe coronary artery disease, potentially reducing the need for routine invasive coronary angiography in TAVR candidates.

Implication

Supports selective ICA omission after negative TAVR CTA; leaves open prospective validation before practice change.

Discussion

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Cite This Study

Gassert et al. (2025) conducted a cross-sectional in Coronary Artery Disease in TAVR candidates (n=599). Single-dose TAVR planning CT angiography vs. Invasive coronary angiography (ICA) was evaluated on Detection of patients with at least one vessel with stenosis of 50% or more (Sensitivity 97.6%, Specificity 84.3%). Single-dose TAVR planning CT angiography accurately detected obstructive coronary artery disease, yielding a per-patient sensitivity of 97.6% and specificity of 84.3% compared to invasive angiography.

synapsesocial.com/papers/6a885ca986ac178e8f609771 https://doi.org/10.1097/rti.0000000000000824