A systematic report on non-coronary cardiac CTA in 1097 patients from the German cardiac CT registry. Issue 130 (September 2020)

• Record Type: Journal Article
• Authors: Gitsioudis, Gitsios; Marwan, Mohamed; Schneider, Steffen; Schmermund, Axel; Korosoglou, Grigorios; Hausleiter, Jörg; Schroeder, Stephen; Rixe, Johannes; Leber, Alexander; Bruder, Oliver; Katus, Hugo A.; Senges, Jochen; Achenbach, Stephan
• Is Part Of: European journal of radiology. Issue 130(2020)
• Publication Date: 2020-09
• Subjects: Non-coronary CTA -- Pulmonary veins -- TAVI -- Valvular disease; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109136
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Non-coronary cardiac CTA continuously gains importance for diagnostic workup in clinical cardiology. Non-coronary cardiac CTA is associated with a very low procedure-related rate of complications. Radiation exposure is reasonably low by using contemporary CT systems for non-coronary cardiac CTA. Abstract: Purpose: To prospectively evaluate contemporary indications, safety and diagnostic impact of cardiac CTA in patients undergoing cardiac CTA examinations for non-coronary clinical indications. Method: We analyzed 1097 consecutive patients from the German Cardiac CT Registry who underwent cardiac CTA between 2009 and 2014 due to clinically indicated non-coronary reasons using 64-slice or newer CT systems in twelve tertiary German heart centers in order to evaluate the impact of clinical indications on procedure-associated parameters. All participating centers electronically submitted patient and examination data including detailed indications, clinical symptoms, procedural parameters, complications and diagnostic results in a predefined template. Results: The most frequent indication for non-coronary cardiac CTA was the evaluation of pulmonary vein anatomy (65.9 %, 723/1097). In the remaining cases, most frequent indications were planning before TAVI (44.5 %, 69/155), evaluation of valvular disease (31.6 %, 49/155), and evaluation of implants (5.8 %, 9/155). Non-coronary cardiac CTA required a median amount of iodinated contrast agent of 100.0 mL (IQR 95.0–110.0 mL). Prospectively ECG-triggered acquisition was the most frequently used protocol (74.0 %), followed by retrospectively ECG-gated acquisition with and without tube current modulation (19.9 % and 6.0 %, respectively), resulting in a mean estimated effective dose of 5.2 mSv (IQR 2.9−9.5 mSv, average conversion factor k = 0.026). Overall, complication rate was very low (1.5 %). Non-coronary cardiac CTA revealed a new clinical diagnostic aspect in 3.2 % of all patients, and a new main clinical diagnosis in 2.2 %. Conclusions: Non-coronary cardiac CTA as a routinely applied diagnostic modality is associated with a very low procedure-related rate of complications and reasonably low radiation exposure using contemporary CT systems.