Pre-procedural assessment of aortic annulus dimensions for transcatheter aortic valve replacement: comparison of a non-contrast 3D MRA protocol with contrast-enhanced cardiac dual-source CT angiography.

Ruile, Philipp; Blanke, Philipp; Krauss, Tobias; Dorfs, Stephan; Jung, Bernd; Jander, Nikolaus; Leipsic, Jonathon; Langer, Mathias; Neumann, Franz-Josef; Pache, Gregor (2016). Pre-procedural assessment of aortic annulus dimensions for transcatheter aortic valve replacement: comparison of a non-contrast 3D MRA protocol with contrast-enhanced cardiac dual-source CT angiography. European heart journal - cardiovascular imaging, 17(4), pp. 458-466. Oxford University Press 10.1093/ehjci/jev188

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AIMS To evaluate the feasibility of a non-contrast three-dimensional (3D)-FLASH magnetic resonance angiography (MRA) protocol for pre-procedural aortic annulus assessment for transcatheter aortic valve replacement (TAVR) in comparison with cardiac dual-source computed tomography angiography (CTA). METHODS AND RESULTS In this prospective study, 69 of 104 consecutive patients (mean age 81.8 ± 5.4 years, 37.7% arrhythmic) with severe aortic stenosis who had undergone pre-TAVR cardiac CTA received a respiratory and ECG-triggered, non-contrast 3D-FLASH MRA at 3 T. Annular area measurements were obtained at mid-diastole for both modalities whereas maximum systolic area was assessed by CTA only. Systolic MRA dimensions were modelled, by adding the relative difference of systolic and diastolic CTA area dimensions as a corrective factor. Hypothetical prosthesis sizing was performed based on systolic CTA, diastolic, and modelled systolic MRA area measurements. MR image quality and degree of annular calcifications were evaluated using 4-point-grading scales. The mean acquisition time was 14 ± 4.2 min. The mean image quality was 3.1 ± 0.9 with only two examinations rated non-diagnostic. The mean degree of calcifications was equal. As assessed by Bland-Altman analysis, there was no relevant systematic difference between area measurements for modelled systolic MRA and systolic CTA [the mean difference -3.1 mm(2) (limits of agreement -44.4 mm(2); 38.2 mm(2))]. Agreement for hypothetical prosthesis sizing was found in 63 of 67 (94%) patients for systolic CTA and modelled systolic MRA. CONCLUSION The employed non-contrast 3D-FLASH MRA protocol allows for reliable assessment of aortic annulus dimensions and calcifications even in the presence of arrhythmias in an all-comers pre-TAVR population. Implementation of this technique appears legitimate in patients at an increased risk for contrast-induced nephropathy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Jung, Bernd

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-2412

Publisher:

Oxford University Press

Language:

English

Submitter:

Karin Hofmann

Date Deposited:

19 Apr 2017 16:12

Last Modified:

19 Apr 2017 16:12

Publisher DOI:

10.1093/ehjci/jev188

PubMed ID:

26219296

Uncontrolled Keywords:

TAVI; TAVR; computed tomography; magnetic resonance angiography; transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.94112

URI:

https://boris.unibe.ch/id/eprint/94112

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