Very low intravenous contrast volume protocol for computed tomography angiography providing comprehensive cardiac and vascular assessment prior to transcatheter aortic valve replacement in patients with chronic kidney disease

J Cardiovasc Comput Tomogr. 2016 Jul-Aug;10(4):316-21. doi: 10.1016/j.jcct.2016.03.005. Epub 2016 Mar 28.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is a lifesaving procedure for many patients high risk for surgical aortic valve replacement. The prevalence of chronic kidney disease (CKD) is high in this population, and thus a very low contrast volume (VLCV) computed tomography angiography (CTA) protocol providing comprehensive cardiac and vascular imaging would be valuable.

Methods: 52 patients with severe, symptomatic aortic valve disease, undergoing pre-TAVR CTA assessment from 2013-4 at Columbia University Medical Center were studied, including all 26 patients with CKD (eGFR<30 mL/min) who underwent a novel VLCV protocol (20 mL of iohexol at 2.5 mL/s), and 26 standard-contrast-volume (SCV) protocol patients. Using a 320-slice volumetric scanner, the protocol included ECG-gated volume scanning of the aortic root followed by medium-pitch helical vascular scanning through the femoral arteries. Two experienced cardiologists performed aortic annulus and root measurements. Vascular image quality was assessed by two radiologists using a 4-point scale.

Results: VLCV patients had mean (±SD) age 86 ± 6.5, BMI 23.9 ± 3.4 kg/m(2) with 54% men; SCV patients age 83 ± 8.8, BMI 28.7 ± 5.3 kg/m(2), 65% men. There was excellent intra- and inter-observer agreement for annular and root measurements, and excellent agreement with 3D-transesophageal echocardiographic measurements. Both radiologists found diagnostic-quality vascular imaging in 96% of VLCV and 100% of SCV cases, with excellent inter-observer agreement.

Conclusions: This study is the first of its kind to report the feasibility and reproducibility of measurements for a VLCV protocol for comprehensive pre-TAVR CTA. There was excellent agreement of cardiac measurements and almost all studies were diagnostic quality for vascular access assessment.

Keywords: Chronic kidney disease; Computed tomography angiography; Transcatheter aortic valve replacement; Very low contrast volume.

MeSH terms

  • Academic Medical Centers
  • Administration, Intravenous
  • Aged
  • Aged, 80 and over
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods*
  • Computed Tomography Angiography / adverse effects
  • Computed Tomography Angiography / methods*
  • Contrast Media / administration & dosage*
  • Contrast Media / adverse effects
  • Coronary Angiography / adverse effects
  • Coronary Angiography / methods*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Vessels / diagnostic imaging*
  • Feasibility Studies
  • Female
  • Glomerular Filtration Rate
  • Heart Valve Diseases / complications
  • Heart Valve Diseases / diagnostic imaging*
  • Heart Valve Diseases / therapy
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Iohexol / administration & dosage*
  • Iohexol / adverse effects
  • Kidney / physiopathology
  • Male
  • Multidetector Computed Tomography / adverse effects
  • Multidetector Computed Tomography / methods*
  • New York City
  • Observer Variation
  • Predictive Value of Tests
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / physiopathology
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Contrast Media
  • Iohexol