Cardiac CT Imaging Offers Advantage Over Echo For Assessment of Patients Undergoing TAVI

December 15, 2011 – A single center study recently published in the November 15, 2011 issue of the Journal of the American College of Cardiology (JACC) suggests that both cardiac computed tomography (cardiac CT) and cardiovascular magnetic resonance (CMR) are superior to transthoracic echocardiography (TTE) in the assessment of patients undergoing transcatheter aortic valve implantation (TAVI).

"Multimodality Imaging in Transcatheter Aortic Valve Implantation and Post-Procedural Aortic Regurgitation: Comparison Among Cardiovascular Magnetic Resonance, Cardiac Computed Tomography, and Echocardiography", was reported by Raad H. Mohiaddin, M.D., and colleagues, of the Royal Brompton Hospital in the U.K., with the intent to determine imaging predictors of aortic regurgitation (AR) after TAVI and the agreement and reproducibility of CMR, CCT and TTE in aortic root assessment. The study included 202 consecutive patients assessed by CMR, cardiac CT and TTE for TAVI.

Researchers concluded that in patients undergoing imaging assessment for TAVI, the presence and severity of paravalvular AR after TAVI were associated with larger aortic annulus measurements by both CMR and cardiac CT, but not TTE. Both CMR and cardiac CT could prove valuable in providing more accurate and highly reproducible information in the assessment of patients undergoing TAVI, and predicting outcome after TAVI.

The abstract of the article can be viewed here.

A similar article may also be of interest, "Aortic Annulus Diameter Determination by Multidetector Computed Tomography: Reproducibility, Applicability and Implications for Transcatheter Aortic Valve Implantation," published on line in this month's JACC Cardiovascular Interventions. This manuscript builds on these same principles of a high degree of measurement reproducibility with CT. The authors report the highest degree of reproducibility in annular assessment with area and bi-dimensional measurements of the aortic root. The researchers then propose a CT-based sizing scale for TAVR in an attempt to enable proper and thoughtful integration of these CT measurements into the evaluation for patients pre-TAVR and into the transcatheter heart valve sizing and selection process.

Both of these manuscripts represent important steps forward to enable proper understanding of the strengths of MDCT in the evaluation of these patients and will hopefully motivate further study in this field.

The abstract of this article can be viewed here.

For more information: www.SCCT.org