{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:18:04Z","timestamp":1783577884818,"version":"3.55.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T00:00:00Z","timestamp":1623801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T00:00:00Z","timestamp":1623801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>Computed tomography angiography (CTA) is performed routinely in the work-up for transcatheter aortic valve implantation (TAVI), and could potentially replace invasive coronary angiography (ICA) to rule out left main (LM) and proximal coronary stenosis. The objectives were to assess the diagnostic yield and accuracy of pre-TAVI CTA to detect LM and proximal coronary stenosis of \u2265 50% and \u2265 70% diameter stenosis (DS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The DEPICT CTA database consists of individual patient data from four studies with a retrospective design that analyzed the diagnostic accuracy of pre-TAVI CTA to detect coronary stenosis, as compared with ICA. Pooled data were used to assess diagnostic accuracy to detect coronary stenosis in the left main and the three proximal coronary segments on a per-patient and a per-segment level. We included 1060 patients (mean age: 81.5 years, 42.7% male).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>On ICA, the prevalence of proximal stenosis was 29.0% (\u2265 50% DS) and 15.7% (\u2265 70% DS). Pre-TAVI CTA ruled out \u2265 50% DS in 51.6% of patients with a sensitivity of 96.4%, specificity of 71.2%, PPV of 57.7%, and NPV of 98.0%. For \u2265 70% DS, pre-TAVI CTA ruled out stenosis in 70.0% of patients with a sensitivity of 96.7%, specificity of 87.5%, PPV of 66.9%, and NPV of 99.0%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>CTA provides high diagnostic accuracy to rule out LM and proximal coronary stenosis in patients undergoing work-up for TAVI. Clinical application of CTA as a gatekeeper for ICA would reduce the need for ICA in 52% or 70% of patients, using a threshold of \u2265 50% or \u2265 70% DS, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p>\u2022 <jats:italic>Clinical application of CTA as a gatekeeper for ICA would reduce the need for ICA in 52% or 70% of TAVI patients, using a threshold of \u2265 50% or \u2265 70% diameter stenosis<\/jats:italic>.<\/jats:p>\n                <jats:p>\u2022 <jats:italic>The diagnostic accuracy of CTA to exclude proximal coronary stenosis in these patients is high, with a sensitivity of 96.4% and NPV of 98.0% for a threshold of \u2265 50%, and a sensitivity of 96.7% and NPV of 99.0% for a threshold of \u2265 70% diameter stenosis<\/jats:italic>.<\/jats:p>\n                <jats:p>\u2022 <jats:italic>Atrial fibrillation and heart rate did not significantly affect sensitivity and NPV. However, a heart rate of &lt; 70 b\/min during CTA was associated with a significantly improved specificity and PPV<\/jats:italic>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-021-08095-2","type":"journal-article","created":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T05:03:06Z","timestamp":1623819786000},"page":"143-151","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["DEtection of ProxImal Coronary stenosis in the work-up for Transcatheter aortic valve implantation using CTA (from the DEPICT CTA collaboration)"],"prefix":"10.1007","volume":"32","author":[{"given":"Thomas P. W.","family":"van den Boogert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bimmer E. P. 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The previous studies described the diagnostic accuracy of CTA, as compared to invasive coronary angiography, to diagnose coronary lesions in all segments of the coronary tree in patients who underwent TAVI. The current study combines the cohorts of the previous studies and investigates the diagnostic accuracy of CTA, as compared to invasive coronary angiography, in the proximal coronary segments only.The studies that described study subjects, included in the current cohort:1. Andreini D, Pontone G, Mushtaq S, Bartorelli AL, Ballerini G, Bertella E, et al Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement. <i>Am Heart J<\/i> [Internet]. 2014;168(3):332\u20139. Available from: 2. Rossi A, De Cecco CN, Kennon SRO, Zou L, Meinel FG, Toscano W, et al CT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic valve replacement. <i>J Cardiovasc Comput Tomogr<\/i>. 2017;11(5):338\u201346.3. Hamdan A, Wellnhofer E, Konen E, Kelle S, Goitein O, Andrada B, et al Coronary CT angiography for the detection of coronary artery stenosis in patients referred for transcatheter aortic valve replacement. <i>J Cardiovasc Comput Tomogr<\/i> [Internet]. 2015;9(1):31\u201341. Available from: 4. Opolski MP, Christoph WK, Linden A Van, Walther T, Hamm CW, Mo H. Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation. 2015;471\u201380.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 Retrospective\u2022 Diagnostic or prognostic\u2022 Multicenter study","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}