Feasibility of a High-Pitch Protocol for Transcatheter Aortic Valve Replacement Evaluation in Patients not Suitable for ECG-Gated CT

High-Pitch CT for TAVR Evaluation in Patients not Suitable for ECG-GatingThe use of transcatheter aortic valve replacement (TAVR) has been established to be non-inferior to surgical aortic valve replacement (SAVR). As a result, in the United States, more patients now undergo TAVR than SAVR. It is recommended that preprocedural CT imaging for aortic valve evaluation and optimal sizing should include an ECG-gated scan of, at least, the aortic root. However, many patients suffer from concomitant tachyarrhythmias such as atrial fibrillation, which may seriously degrade the diagnostic accuracy of ECG-gated scans. The aim of the present study is to explore whether a high-pitch non-ECG-gated computed tomography angiography (CTA) of the entire aorta can render similar diagnostic preprocedural images as a standard ECG-gated scan. 108 patients were included. Objective image quality parameters such as image noise, CNR and SNR as well as subjective image quality analysis by two different readers were compared. The results showed a significant increase in image noise at the level of the aortic root with use of the high-pitch protocol (p = 0.001). Otherwise, our study revealed no significant differences in subjective and objective image quality. Diagnostic image quality was achieved in all patients without a record of inaccurate sizing in the surgical reports or subsequent patient histories.

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