Key result
In TAVI candidates, CCTA had a pooled sensitivity of 94.3% and specificity of 74.8% for obstructive CAD, while CT-FFR showed higher specificity (92.9% vs 64.4%) in direct comparison studies.
Why the study?
Screening for CAD with CCTA during TAVI work-up could prevent unnecessary ICA, but the reliability and diagnostic accuracy of CT-FFR in the growing TAVI population is unknown.
Do CCTA and CT-FFR accurately identify and rule out obstructive CAD in candidates for trans-catheter aortic valve implantation?
Meta-Analysis (n=3,494)
Do CCTA and CT-FFR accurately identify and rule out obstructive CAD in candidates for trans-catheter aortic valve implantation?
Negative CCTA effectively rules out obstructive CAD in TAVI candidates, potentially reducing unnecessary invasive coronary angiography, though false-positive rates remain high and the added value of CT-FFR remains unclear.
Answers are grounded in this paper and cite their sources.
CCTA supports ruling out CAD pre-TAVI; extends evidence by demonstrating CT-FFR's superior specificity in direct comparisons.
Objectives To perform a systematic review and meta-analysis on diagnostic accuracy and other outcomes of coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) in candidates for trans-catheter aortic valve implantation (TAVI). Background Screening for obstructive coronary artery disease (CAD) with CCTA during TAVI work-up could prevent unnecessary invasive coronary angiography (ICA). This becomes increasingly relevant as the TAVI-population grows. CT-FFR improves CCTA accuracy in chest pain patients, but its reliability is unknown in the TAVI-population. Methods Pubmed, Embase and Web of Science were searched for studies regarding CCTA and/or CT-FFR in TAVI-candidates. Primary endpoint was correct identification and rule-out of obstructive CAD. Results were pooled in a meta-analysis. Results Twenty-four of the 29 included articles were part of the meta-analysis, reporting results for CCTA and CT-FFR in 3.494 and 797 patients respectively. Reference standard was anatomical severity of CAD in most studies. At patient-level, pooled CCTA sensitivity was 94.3% and specificity 74.8%. CT-FFR sensitivity was 91.5% and specificity 60.3% with strong variation between studies. CCTA correctly ruled out CAD in 52% of all patients, but 42% of positive CCTAs were false positives. CT-FFR correctly ruled out CAD in 47% of all patients included in this meta-analysis, but showed better accuracy than CCTA in studies that compared both. In these studies, sensitivity of CCTA versus CT-FFR was 70.7% versus 79.0% and specificity was 64.4% versus 92.9%. Conclusions Negative CCTA effectively rules-out CAD in the TAVI-population. Adding CCTA to TAVI work-up could lead to significant reduction in pre-TAVI ICA procedures, but the proportion of false-positives remains high. In studies performing a direct comparison, CT-FFR performed better than CCTA. This is not reflected in the CT-FFR meta-analysis. Therefore, diagnostic accuracy of CT-FFR and added value over CCTA in the TAVI-population remains unclear. Further research regarding validation and reliability is warranted.
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Becker et al. (2024) conducted a meta-analysis in Trans-catheter aortic valve implantation (TAVI) candidates (n=3,494). Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) vs. Anatomical severity of CAD (reference standard) was evaluated on Correct identification and rule-out of obstructive CAD. In TAVI candidates, CCTA had a pooled sensitivity of 94.3% and specificity of 74.8% for obstructive CAD, while CT-FFR showed higher specificity (92.9% vs 64.4%) in direct comparison studies.
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