Introduction
Materials and methods
Ethics statement
Patient sample
CT acquisition protocol
CT reconstructions
Analysis of CT data
Aortic annulus assessment: subjective image quality
Aortic annulus assessment: objective image quality
Quantitative measurements of the aortic annulus area and the aortic annulus perimeter
Hypothetical aortic valve prosthesis selection
Statistics
Results
Patient sample
Characteristics | Values |
---|---|
Number of patients | 64 (100%) |
Gender | |
Male | 36 (56%) |
Female | 28 (44%) |
Age | 81.4 ± 6.9 |
Height (cm) | 168.4 ± 8.5 |
Weight (kg) | 76.1 ± 13.8 |
Sinus Rhythm | 47 (71%) |
Heart Rate (bpm) during CTA | 73 ± 13 (range 36–136) |
Heart Rate Variabilty during CTA | 015 [0.04–0.38] |
Body-Mass-Index (kg/m2) | 26.9 ± 4.6 |
Cardiovascular Risk Factors and Assessment | |
Coronary Artery Disease | 22 (34%) |
Arterial Hypertension | 53 (83%) |
Diabetes Mellitus | 14 (22%) |
Hyperlipidemia | 41 (64%) |
Smoking | 18 (28%) |
History of Stenting | 15 (23%) |
Chronic Kidney Disease (eGFR ≤ 45 ml/min*1.72m2) | 18 (28%) |
Evaluation of subjective and objective image quality
Retrospective UHR cardiac CTA | Prospective High-Pitch aortoiliac CTA | p–value | |
---|---|---|---|
Image Quality Score | 4 [3, 4] | 3 [2, 3] | < 0.001 |
Aortic Root attenuation | 435 ± 84 | 325 ± 85 | < 0.001 |
Image noise | 31.4 ± 8.5 | 22.0 ± 7.1 | < 0.001 |
Signal-to-noise ratio | 14.7 ± 4.4 | 16.2 ± 5.9 | < 0.001 |
Contrast-to-noise ratio | 16.7 ± 4.9 | 19.0 ± 6.5 | < 0.001 |
CTDIvol (mGy) | 65.9 [54.6–80.1] | 4.3 [3.8–5.4] | < 0.001 |
DLP (mGy*cm) | 902 [736–1071] | 292 [262–365] | < 0.001 |
Effective Dose (mSv) | 12.6 [10.3–15.0] | 4.1 [3.7–5.1] | < 0.001 |
Quantitative measurements of the aortic annular area and the aortic annular perimeter
Linear regression | Difference in aortic annular area | |
---|---|---|
β | p-value | |
BMI (kg/m2) | −0.32 | 0.1 |
CTDIvol (mGy) | 0.25 | 0.2 |
HF mean (bpm) | −0.08 | 0.5 |
HF-Variability | −0.005 | 0.97 |
Average HU attenuation | 0.26 | 0.09 |
CNR | −0.07 | 0.6 |
Subjective Image Quality of HPS-CTA | 0.5 | < 0.001 |
Hypothetical aortic valve prosthesis selection
Area based prosthesis sizing for balloon-expandable SAPIEN 3 | |||||
---|---|---|---|---|---|
UHR–CTA | |||||
Valve size | 20 mm | 23 mm | 26 mm | 29 mm | |
HPS–CTA | 20 mm | 1 | 0 | 0 | 0 |
23 mm | 0 | 18 | 2 | 0 | |
26 mm | 0 | 2 | 28 | 2 | |
29 mm | 0 | 0 | 0 | 11 |
Perimeter based prosthesis sizing for self-expandable Evolute R | |||||
---|---|---|---|---|---|
UHR–CTA | |||||
Valve size | 23 mm | 26 mm | 29 mm | 34 mm | |
HPS–CTA | 23 mm | 0 | 0 | 0 | 0 |
26 mm | 0 | 12 | 1 | 0 | |
29 mm | 0 | 3 | 30 | 1 | |
34 mm | 0 | 0 | 2 | 15 |
Identical prosthesis sizing | ||
---|---|---|
Sapien 3 | Evolute R | |
Total (n = 64) | 58/64 (91%) | 57/64 (89%) |
High IQ, (n = 36) | 35/36 (97%) | 34/36 (94%) |
Low IQ (n = 28) | 23/28 (82%) | 23/28 (82%) |