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Gianluca Pontone,
Daniele Andreini,
Antonio L Bartorelli,
Erika Bertella,
Sarah Cortinovis,
Saima Mushtaq,
Andrea Annoni,
Alberto Formenti, Andrea Baggiano,
Edoardo Conte,
Gloria Tamborini,
Manuela Muratori,
Paola Gripari,
Francesca Bovis,
Fabrizio Veglia,
Claudia Foti,
Francesco Alamanni,
Giovanni Ballerini,
Cesare Fiorentini,
Mauro Pepi
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ABSTRACT: Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgery in high-risk patients with severe aortic stenosis. Aortic annulus (AoA) sizing is crucial for TAVI success. The aim of the study was to compare AoA dimensions measured by multidetector computed tomography (MDCT) vs those obtained with transthoracic (TTE) and transesophageal echocardiography (TEE) for predicting paravalvular aortic regurgitation (PVR) after TAVI.
Aortic annulus maximum diameter, minimum diameter, and area were assessed using MDCT and compared with TTE and TEE diameter and area for predicting PVR after TAVI in 151 patients (45 men, age 81.2 ± 6.4 years).
Aortic annulus maximum, minimum diameter, and area detected by MDCT were 25.04 ± 2.39 mm, 21.27 ± 2.10 mm, and 420.87 ± 76.10 mm(2), respectively. Aortic annulus diameter and area measured by TTE and TEE were 21.14 ± 1.94 mm and 353.82 ± 64.57 mm(2) and 22.04 ± 1.94 mm and 384.33 ± 67.30 mm(2), respectively. A good correlation was found between AoA diameters and area evaluated by MDCT vs TTE and TEE (0.61, 0.65, and 0.69 and 0.61, 0.65, and 0.70, respectively), with a mean difference of 3.90 ± 1.98 mm, 0.13 ± 1.67 mm, and 67.05 ± 55.87 mm(2) and 3.0 ± 2.0 mm, 0.77 ± 1.70 mm, and 36.54 ± 56.43 mm(2), respectively. Grade ≥2 PVR occurred in 46 patients and was related to male gender, higher body mass index, preprocedural aortic regurgitation, and lower mismatch between the nominal area of the implanted prosthesis and AoA area detected by MDCT.
Mismatch between prosthesis area and AoA area detected by MDCT is a better predictor of PVR as compared with echocardiography mismatch. Specific MDCT-based sizing recommendations should be developed.
American heart journal 10/2012; 164(4):576-84. · 4.65 Impact Factor
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Gianluca Pontone,
Daniele Andreini,
Erika Bertella,
Sarah Cortinovis,
Saima Mushtaq,
Claudia Foti,
Andrea Annoni,
Alberto Formenti, Andrea Baggiano,
Edoardo Conte,
Giovanni Ballerini,
Cesare Fiorentini,
Antonio L Bartorelli,
Mauro Pepi
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. METHODS: Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. RESULTS: The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. CONCLUSIONS: The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.
International journal of cardiology 09/2012; · 7.08 Impact Factor
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Gianluca Pontone,
Daniele Andreini,
Antonio L Bartorelli,
Erika Bertella,
Saima Mushtaq,
Andrea Annoni,
Alberto Formenti,
Luisa Chiappa,
Sarah Cortinovis, Andrea Baggiano,
Edoardo Conte,
Francesca Bovis,
Fabrizio Veglia,
Claudia Foti,
Giovanni Ballerini,
Cesare Fiorentini,
Mauro Pepi
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ABSTRACT: We conducted a meta-analysis evaluating the critical ratio between effective radiation dose (ED), feasibility (Fe) and diagnostic accuracy (Ac) of multidetector computed tomography (MDCT) for the detection of significant coronary artery disease. By using our predetermined criteria, we selected human studies published in English in which the ED and raw data of Ac vs. invasive coronary angiography in a segment based model were specified. Data from 31 studies including 3661 patients (mean age 61.9±4.5years, heart rate 62.5±6.7bpm) and 50,236 coronary artery segments were analysed and are reported. Overall, Fe, sensitivity, specificity, negative predictive value, positive predictive value, Ac and ED were 95%, 90%, 96%, 99%, 69%, 95% and 10.4±5.4mSv, respectively. Multivariate analysis showed that prospective ECG-gating (-8.8mSv CI95% -13.4 to -4.3mSv, p=0.001), dual-source (-3.7mSv CI95% -7.9 to 0mSv, p=0.05) and BMI-adapted scanning protocols (-4.5mSv CI95% -8.7 to -2.7mSv, p=0.03) were independent predictors of ED reduction. In patients with low heart rate, the best compromise between ED, Fe and Ac (2.5mSv, 97% and 98%, respectively) was obtained combining prospective ECG-gating and BMI-adapted scanning protocols, while in patients with high heart rate the strategy associated with the best results (10mSv, 98% and 97%, respectively) was the use of dual-source MDCT with retrospective ECG gating and modulation dose. In conclusion, careful selection of CT scanning protocols according to the patient's characteristics is critical for keeping the radiation exposure "as low as reasonably achievable" (ALARA) without impairing Fe and Ac.
International journal of cardiology 10/2011; 160(3):155-64. · 7.08 Impact Factor
