Meta-Analysis of the Diagnostic Performance of Stress Perfusion Cardiovascular Magnetic Resonance for Detection of Coronary Artery Disease

OBJECTIVES: Evaluation of the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance for the diagnosis of significant obstructive coronary artery disease (CAD) through meta-analysis of the available data.

METHODS: Original articles in any language published before July 2009 were selected from available databases (MEDLINE, Cochrane Library and BioMedCentral) using the combined search terms of magnetic resonance, perfusion, and coronary angiography; with the exploded term coronary artery disease. Statistical analysis was only performed on studies that: (1) used a [greater than or equal to] 1.5 Tesla MR scanner; (2) employed invasive coronary angiography as the reference standard for diagnosing significant obstructive CAD, defined as a [greater than or equal to] 50% diameter stenosis; and (3) provided sufficient data to permit analysis.

RESULTS: From the 263 citations identified, 55 relevant original articles were selected. Only 35 fulfilled all of the inclusion criteria, and of these 26 presented data on patient-based analysis. The overall patient-based analysis demonstrated a sensitivity of 89% (95% CI: 88-91%), and a specificity of 80% (95% CI: 78-83%). Adenosine stress perfusion CMR had better sensitivity than with dipyridamole (90% (88-92%) versus 86% (80-90%), P = 0.022), and a tendency to a better specificity (81% (78-84%) versus 77% (71-82%), P = 0.065).

CONCLUSIONS: Stress perfusion CMR is highly sensitive for detection of CAD but its specificity remains moderate.

PMID: 20482819

Prevalence, Distribution and Risk Factor Correlates of High Pericardial and Intra-thoracic Fat Depots in the Framingham Heart Study

OBJECTIVES: Pericardial and intra-thoracic fat depots may represent novel risk factors for obesity-related cardiovascular disease. We sought to determine the prevalence, distribution and risk factor correlates of high pericardial and intra-thoracic fat deposits.

METHODS: Participants from the Framingham Heart Study (n=3312; mean age 52 years, 48% women) underwent multi-detector CT imaging in 2002-2005; high pericardial and high intra-thoracic fat were defined based on the sex-specific 90th percentile for these fat depots in a healthy reference sample.

RESULTS: For men and women, the prevalence of high pericardial fat was 29.3% and 26.3%, respectively, and high intra-thoracic fat was 31.4% and 35.3%, respectively. Overall, 22.1% of the sample was discordant for pericardial and intra-thoracic fat depots: 8.3% had high pericardial but normal intra-thoracic fat, and 13.8% had high intra-thoracic but normal pericardial fat. Higher body mass index, higher waist circumference (WC) and increased prevalence of metabolic syndrome were more likely in participants with high intra-thoracic fat depots than with high pericardial fat (p<0.05 for all comparisons). High abdominal visceral adipose tissue was more frequent in participants with high intra-thoracic adipose tissue compared to those with high pericardial fat (p<0.001). Intra-thoracic fat, but not WC, was more highly correlated with VAT (r=0.76 and 0.78 in men and women, respectively; p<0.0001) than with SAT (r=0.46 and 0.54 in men and women, respectively; p<0.0001).

CONCLUSIONS: Although prevalence of pericardial fat and intra-thoracic fat were comparable at 30%, intra-thoracic fat correlated more closely with metabolic risk and visceral fat. Intra-thoracic fat may be a potential marker of metabolic risk and visceral fat on thoracic imaging.

PMID: 20525769

Influence of Slice Thickness and Reconstruction Kernel on the Computed Tomographic Attenuation of Coronary Atherosclerotic Plaque

OBJECTIVE: The computed tomographic (CT) attenuation of coronary atherosclerotic plaque has been proposed as a marker for tissue characterization and may thus potentially contribute to the assessment of plaque instability.We analyzed the influence of reconstruction parameters on CT attenuation measured within noncalcified coronary atherosclerotic lesions.

METHODS: Seventy-two patients were studied by contrast-enhanced dual-source CT coronary angiography (330 millisecond rotation time, 2 x 64 x 0.6 mm collimation, 120 kV, 400 mAs, 80 mL contrast agent intravenously at 6 mL/s), and a total of 100 distinct noncalcified coronary atherosclerotic plaques were identified. Image data sets were reconstructed with a soft (B20f), medium soft (B26f), and sharp (B46f) reconstruction kernel. With the medium soft kernel, image data sets were reconstructed with a slice thickness/increment of 0.6/0.3 mm, 0.75/0.4 mm, and 1.0/0.5mm. Within each plaque, CT attenuation was measured.

RESULTS: Mean CT attenuation using the medium soft kernel was 109 +/- 58 HU (range, -16 to 168 HU). Using the soft kernel, mean density was 113 +/- 57 HU (range, -13 to 169 HU), and using a sharp kernel, mean density was 97 +/- 49 HU (range, -23 to 131 HU). Similarly, reconstructed slice thickness had a significant influence on the measured CT attenuation (mean values for medium soft kernel: 102 +/- 52 HU versus 109 +/- 58 HU versus 113 +/- 57 HU for 0.6-mm, 0.75-mm, and 1.0-mm slice thickness). The differences between 0.75-mm and 0.6-mm slice thickness (P = 0.05) and between medium sharp and sharp kernels (P = 0.02) were statistically significant.

CONCLUSIONS: Image reconstruction significantly influences CT attenuation of noncalcified coronary atherosclerotic plaque. With decreasing spatial resolution (softer kernel or thicker slices), CT attenuation increases significantly. Using absolute CT attenuation values for plaque characterization may therefore be problematic.

PMID: 20430341

Aortic Annulus Evaluation in Transcatheter Aortic Valve Implantation

OBJECTIVES: We compared the annulus diameters measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and dual-source computed tomography (DSCT) prior to transcatheter aortic valve implantation (TAVI). In TAVI correct evaluation of the aortic annulus is mandatory in order to choose the correct prosthesis type and size and to prevent complications. There is no gold standard for the assessment of aortic annulus diameters.

METHODS: Preoperative assessment of the aortic annulus with TTE, TEE and DSCT was performed in 187 consecutive patients referred for TAVI between 06/2007 and 05/2009.

RESULTS: The mean aortic annuli were 22.6+/-2.0mm measured with DSCT, 22.3+/-2.5mm with TTE and 22.9+/-2.2mm with TEE. Despite a strong correlation between the measurement techniques relevant statistical spread occurred with differences up to 3mm in all measurement methods. Inter- and intra-observer variability was good for TEE and less satisfactory for DSCT measurements. TEE measurements taken as decisive parameter for the implantation changed the implantation strategy in 15,5% of patients and did not show an increased rate of procedural complications.

CONCLUSION: Despite a strong correlation, the measurement techniques for the aortic annulus show relevant statistical spread, consequently one measurement technique cannot definitely predict another. TEE measurements show a more satisfactory intra- and inter-observer variability than DSCT. Taking TEE annulus measurements as decisive parameter for the implantation has an impact on the implantation strategy and is safe with a low rate of procedural complications.

PMID: 20518012

Diabetes: Prognostic Value of CT Coronary Angiography: Comparison With a Nondiabetic Population

OBJECTIVES: To evaluate the prognostic value of multidetector computed tomographic (CT) coronary angiography in a diabetic population known to have or suspected of having coronary artery disease (CAD) compared with that in nondiabetic individuals.

METHODS: Institutional review board approval and patient informed consent were obtained. Three hundred thirteen patients with type 2 diabetes mellitus (DM) and 303 patients without DM underwent unenhanced 64-detector row CT, at which a calcium score was obtained, followed by CT angiography. Multidetector CT coronary angiograms were retrospectively classified as normal, showing nonobstructive CAD (<50% luminal narrowing), or showing obstructive CAD (>50% luminal narrowing). During follow-up after CT angiography, major events (cardiac death, nonfatal myocardial infarction, and unstable angina requiring hospitalization) and total events (major events plus coronary revascularizations) were recorded for each patient. Cox proportional hazards analysis and Kaplan-Meier analysis were used to compare survival rates.

RESULTS: In the group of 313 patients with DM, there were 213 men, and the mean age was 62 years +/- 11 (standard deviation). In the group of 303 patients without DM, there were 203 men, and the mean age was 63 years +/- 11. The mean number of diseased segments (5.6 vs 4.4, P = .001) and the rate of obstructive CAD (51% vs 37%, P < .001) were higher in patients with DM. Patients were followed up for a mean of 20 months +/- 5.4 (range, 6-44 months). At multivariate analysis, DM (P < .001) and evidence of obstructive CAD (P < .001) were independent predictors of outcome. Obstructive CAD remained a significant multivariate predictor for both patients with DM and patients without DM. In both patients with DM and patients without DM with absence of disease, the event rate was 0%. The event rate increased to 36% in patients without DM but with obstructive CAD and was highest (47%) in patients with DM and obstructive CAD.

CONCLUSIONS: In both patients with DM and patients without DM, multidetector CT coronary angiography provides incremental prognostic information over baseline clinical variables, and the absence of atherosclerosis at CT coronary angiography is associated with an excellent prognosis. Multidetector CT coronary angiography might be a clinically useful tool for improving risk stratification in both patients with DM and patients without DM.

PMID: 20574086

Non-Sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy and New Ultrasonic Derived Parameters

OBJECTIVES: The mechanism of sudden death in hypertrophic cardiomyopathy (HCM) is ventricular tachyarrhythmia emanating from myocyte disarray, fibrosis, and inhomogeneity in intramyocardial activation. Tissue synchronization imaging (TSI) allows the measurement of regional delay, while two-dimensional strain can be used to identify myocardial fibrosis. The aim of this study was to assess the relationship between new ultrasonically derived parameters and nonsustained ventricular tachycardia (NSVT) in patients with HCM.

METHODS: Ninety-three patients with HCM (mean age, 36 +/- 16 years) and 30 patients with hypertension with secondary left ventricular (LV) hypertrophy (mean age, 42 +/- 10 years; 65% men) were studied. All underwent standard echocardiographic, TSI, and two-dimensional strain examinations. Patients were followed every 3 months for 2 years. Holter monitoring was performed every 3 months. The primary endpoint was the occurrence of NSVT.

RESULTS: Twenty-four patients (26%) had >1 episode of NSVT. Patients with NSVT had a higher value of maximal LV thickness (22 +/- 6 vs 19 +/- 5 mm, P = .04). There were no significant associations between NSVT on Holter monitoring and LV outflow gradient, New York Heart Association class, syncope, and medical therapy. N-terminal pro-brain natriuretic peptide values were significantly (P = .01) higher in patients with NSTV (1034 +/- 1088 vs 561 +/- 593 pg/mL). Patients with HCM and NSVT had (1) similar values on TSI-studied parameters to patients without NSVT, (2) significant reductions in basal and mid septal strain and in basal anterior-septal strain, and (3) more frequently peak systolic strain >-10% (P < .0001). In multivariate analysis, the presence of >3 LV segments with longitudinal two-dimensional strain > -10% (sensitivity, 81%; specificity, 97.1%; area under the curve, 0.944; P < .0001) was an independent predictor of NSVT.

CONCLUSIONS: Using a simple, inexpensive, easily available, and bedside-usable tool, it was possible to recognize with good sensitivity and specificity patients with HCM at higher risk for NSVT.

PMID: 20362415

Prognostic Value of Absence or Presence of Coronary Artery Disease Determined by 64-Slice Computed Tomography Coronary Angiography: A Systematic Review and Meta-Analysis

OBJECTIVES: To determine via a meta-analysis the prognostic value of 64-slice computed tomography angiography (CTA) by quantifying risk of major adverse cardiac events (MACE) in different patient groups classified according to CT angiographic findings.

METHODS: A systematic literature search and meta-analyses was conducted on 10 studies examining stable, symptomatic and intermediate risk patients by 64-slice CTA. Patients were followed up for a mean of 21 month. Patient groups with CT-angiographic non-obstructive (stenosis <50% of luminal narrowing) or obstructive (stenosis >50% of luminal narrowing) CAD were compared to those having normal angiography without CAD. MACE (cardiac death, non-fatal myocardial infarction and revascularization) numbers were used to calculate odds ratios (OR) with 95% confidence interval (CI) in each group.

RESULTS: Ten studies including 5,675 patients were eligible for meta-analysis. The cumulative MACE rate over 21 months were 0.5% in patients with normal CTA, 3.5% in non-obstructive CAD and 16% in obstructive CAD. Compared to normal CTA, non-obstructive CAD was associated with significant increased risk of MACE with OR = 6.68 (3.01-14.82 CI 95%), P = 0.0001. Obstructive CAD was associated with further significant increased risk of MACE with OR = 41.19 (22.56-75.18, CI 95%), P = 0.0001. The studies were homogenous, P-value >0.05 for heterogeneity.

CONCLUSIONS: 64-slice CTA is able to differentiate low-risk from high-risk patients with suspected or known CAD. Absence of CAD predicts excellent prognosis, while obstructive CAD is associated with markedly increased risk of MACE.

PMID: 20549366

Appropriate Use of Transthoracic Echocardiography

OBJECTIVES: The appropriateness criteria for echocardiography were published in 2007 and classified potential procedural indications as appropriate, uncertain, or inappropriate. The appropriate use rates for outpatient transthoracic echocardiography (TTE) by cardiologists have not been well defined. The objective of the present study was to prospectively determine the appropriate use rate of outpatient TTE in a large private practice group of >40 cardiologists (Cardiovascular Consultants, PA, Kansas City, Missouri).

METHODS: For each transthoracic echocardiographic study, we classified the stated reason for the examination into one of the 59 indications specified in the 2007 Appropriateness Criteria for Echocardiography publication. During the study period, 772 transthoracic echocardiographic studies were performed.

RESULTS: Adequate information was available to classify 716 (92.7%) of these studies. The transthoracic echocardiographic studies were appropriately ordered for 533 patients (74%). Symptoms of potential cardiac origin (eg, dyspnea) was the most common reason for TTE (n = 156, 21.8%). The most common inappropriate use was routine repeat evaluation of patients with heart failure and no change in clinical status (n = 74, 10.3%).

CONCLUSIONS: In conclusion, the appropriateness criteria for echocardiography were easily applied to real-world patients. Most patients in our series had undergone TTE for an appropriate indication.

PMID: 20494676

A Retrospective Comparison of Mortality in Critically Ill Hospitalized Patients Undergoing Echocardiography With and Without an Ultrasound Contrast Agent

OBJECTIVES: To compare acute mortality in critically ill hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent (UCA).

BACKGROUND: Because of serious cardiopulmonary reactions reported immediately after administration of perflutren-containing UCAs, the FDA required a black box safety warning for this class of agents, including perflutren protein-type A microspheres injectable suspension.

METHODS: This study used the largest hospital service-level database in the U.S. All adult patients undergoing in-patient echocardiography between January 2003 and October 2005 were identified (n = 2,588,722, of which 22,499 received perflutren protein-type A microspheres injectable suspension). Of the 22,499 contrast echocardiography patients, 2,900 had diagnoses meeting criteria for critical illness (heart failure, acute myocardial infarction, arrhythmia, respiratory failure, pulmonary embolism, emphysema, and pulmonary hypertension). To control for the differences between the contrast and noncontrast patients, we used propensity score matching. Variables used in the construction of the propensity score included comorbidities, demographic factors, hospital-specific factors, level of care, and mechanical ventilation status. Patients receiving contrast echocardiography were matched to 4 control patients who received noncontrast echocardiography. Conditional logistic regression was used to estimate mortality effects.

RESULTS: There were 167 deaths in the study among critically ill patients, 38 of 2,900 from the contrast group and 129 of 11,600 from the control group. The contrast agent was not associated with an increase in same-day mortality (odds ratio: 1.18; 95% confidence interval: 0.82 to 1.71; p = 0.37). Before matching, contrast patients showed greater morbidity than noncontrast patients (Deyo-Charlson comorbidity score 2.45 vs. 2.25, p < 0.0001). After propensity score matching, these differences were significantly reduced, showing that both groups were well balanced.

CONCLUSIONS: There is no increase in mortality in critically ill patients undergoing echocardiography with the UCA compared with case-matched control patients.

PMID: 20541713

Low-Dose Prospective ECG-Triggering Dual-Source CT Angiography in Infants and Children With Complex Congenital Heart Disease: First Experience

OBJECTIVE: To explore the clinical value of low-dose prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography (TTE).

METHODS: Thirty-five patients (mean age: 16 months, range: 2 months to 6 years; male 15; mean weight: 12 kg) underwent low-dose prospective ECG-triggering DSCT angiography and TTE. Surgeries were performed in 29 patients, and conventional cardiac angiography (CCA) was performed in 8 patients. The accuracy was calculated based on the surgical and/or CCA findings. The overall imaging quality was evaluated on a five-point scale.

RESULTS: A total of 146 separate cardiovascular deformities were confirmed. DSCT missed three atrial septal defects and a patent ductus arteriosus. The accuracy of DSCT angiography and TTE was 97.3% (142/146) and 92.5% (135/146), respectively. Overall test parameters for DSCT angiography and TTE were similar (sensitivity, 97.3% vs 92.5%; specificity, 99.8% vs 99.8%). The average subjective image quality score was 4.3 +/- 0.7. The mean effective dose was 0.38 +/- 0.09 mSv.

CONCLUSIONS: Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE. It has great promise to become a commonly used second-line technique for complex CHD.

PMID: 20532783

Determination of Infarct Size and Transmurality by Contrast-Enhanced 3D-Echocardiography

OBJECTIVES: Myocardial infarct scars are usually imagedusing delayed-enhanced cardiac magnetic resonance (DE-cMR).In this study, we tested the hypothesis that the detection andthe quantification of myocardial scars can be evaluated by 3D-Echo.

METHODS: Fifty patients with a healed myocardialinfarction (>3 months) and 10 controls underwent 3D-Echoand DE-cMR within 2 weeks. 3D-Echo images were acquired usingdifferent settings, in the presence or absence of contrast.

RESULTS: The highest contrast-to-noise ratio was obtained using secondharmonic imaging (1.6/3.2 MHz), at an MI of 0.5, in the presenceof contrast. Using this modality, the sensitivity and specificityfor the 3D-Echo detection of cMR scars on a segmental basiswere 78% and 99%, respectively. On a per patient basis, theywere of 96% and 90%, respectively. Good correlation and limitsof agreement were found between the assessment of scar massby 3D-Echo and DE-cMR (r=0.93, p<0.001, bias: 1.4±3.6g),and the concordance between both techniques for the assessmentof scar transmurality was good. Intraobserver, interobserverand day-to-day reproducibility was comparable between 3D-Echoand DE-cMR for both the detection and the quantification ofscars.

CONCLUSIONS: Contrast-enhanced 3D-Echo is a promising newtool for the detection and the quantification of myocardialinfarct scars.

PMID:

Dyssynchrony By Speckle-Tracking Echocardiography and Response to Cardiac Resynchronization Therapy: Results of the Speckle Tracking and Resynchronization (STAR) Study

OBJECTIVES: The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT).

METHODS: We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) ≤35%, and QRS ≥120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (≥130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device.

RESULTS: Of 120 patients (91%) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 ± 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86% for predicting EF response with a specificity of 67%. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53%, in contrast to events occurring in 12% if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT.

CONCLUSIONS: Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.

PMID:

Imaging: Imaging of atherosclerosis: Carotid Intima–Media Thickness

Carotid ultrasound provides quantitative measurements of carotid intima–media thickness (CIMT) that can be used to assess cardiovascular disease (CVD) risk in individuals and monitor ongoing disease progression and regression in clinical trials. It is non-invasive, rapid, reproducible, and carries no risk. Numerous epidemiological studies have established that CIMT is a marker of subclinical atherosclerosis and is associated with established CVD risk factors and with both prevalent and incident CVD. The use of CIMT in outcome trials as a surrogate or predictor of CVD outcomes is widespread. Carotid ultrasound is being employed to test the efficacy of CVD treatment in order to identify potential useful drugs earlier and to possibly speed regulatory approval. Successive trials have generated lessons learned and applied, with slow but steady improvement in CIMT measurement reproducibility.

PMID:

Intravascular Ultrasound-Derived Measures of Coronary Atherosclerotic Plaque Burden and Clinical Outcome

OBJECTIVES: The aim of this study was to investigate the relationship between intravascular ultrasound (IVUS)-derived measures of atherosclerosis and cardiovascular outcomes. IVUS has been used in clinical trials to evaluate the effect of medical therapies on coronary atheroma progression.

METHODS: Coronary plaque progression was evaluated in 4,137 patients in 6 clinical trials that used serial IVUS. The relationship between baseline and change in percent atheroma volume (PAV) and total atheroma volume with incident major adverse cardiovascular events (MACE) was investigated.

RESULTS: PAV increased by 0.3% (p < 0.001), and 19.9% of subjects experienced MACE (0.9% death, 1.8% myocardial infarction, 18.9% coronary revascularization). Greater baseline PAVs were observed in patients who experienced myocardial infarctions (42.2 +/- 9.6% vs. 38.6 +/- 9.1%, p = 0.001), coronary revascularization (41.2 +/- 9.3% vs. 38.1 +/- 9.0%, p < 0.001), or MACE (41.3 +/- 9.2% vs. 38.0 +/- 9.0%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.32-fold (95% confidence interval: 1.22 to 1.42; p < 0.001) greater likelihood of experiencing a MACE. During follow-up (21.1 +/- 3.7 months), greater increases in PAV, but not total atheroma volume, were observed in subjects who experienced MACE compared with those who did not (0.95 +/- 0.19% vs. 0.46 +/- 0.16%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.20-fold (95% confidence interval: 1.10 to 1.31; p < 0.001) greater risk for MACE. Multivariate analysis revealed that factors associated with MACE included baseline PAV (p < 0.0001), change in PAV (p = 0.002), smoking (p = 0.0002) and hypertension (p = 0.01).

CONCLUSIONS: A direct relationship was observed between the burden of coronary atherosclerosis, its progression, and adverse cardiovascular events. The relationship between disease progression and outcomes largely reflected the need for coronary revascularization. These data support the use of atherosclerosis imaging with IVUS in the evaluation of novel antiatherosclerotic therapies.

PMID: 20488313

“Device Landing Zone” Calcification, Assessed by MSCT, as a Predictive Factor for Pacemaker Implantation After TAVI

OBJECTIVES: After trans-catheter aortic valve implantation (TAVI), the need for post-interventional pacemaker (PM) implantation can occur in as many as 10%-50% of cases, but it is not yet clear, how this need can be predicted. The aim of this study was to assess the possible predictive factors of post TAVI PM implantation, based on Computed Tomography (CT) measured aortic valve calcification and its distribution.

METHODS: We prospectively analyzed 81 consecutive symptomatic patients with severe AS scheduled for TAVI using the CoreValve prosthesis (Medtronic, Minneapolis, USA). In all patients, a native and contrast-enhanced multi-slice cardiac CT was performed pre-interventionally, estimating calcification load of the native valve cusps and of the adjacent outflow tract (so called “device landing zone” – DLZ) by the Agatston Score (AgS). Objective, computer-evaluated, pre-procedural ECG-analysis was performed with regards to pre-existing conduction abnormalities. Transthoracic echocardiography was performed pre and post TAVI.

RESULTS: TAVI was successful in all cases. PM implantation was deemed necessary in altogether 32 patients, out of 67 without a PM pre-TAVI (32/67, 47%). Various parameters were tested as predictors of post TAVI PM in a multivariate logistic regression analysis model.Female sex (p=0,005) and depressed EF (p=0,023) showed a significant correlation. PM implantation correlated also to the DLZ calcification, as assessed by CT (p=0,004). This model leads to an AUC (area under the ROC -receiver operator characteristics – curve) of 0,83.

CONCLUSION: Calcium amount in the CoreValve DLZ in combination with clinical data could predict the need for post TAVI PM implantation.

PMID: 20506410