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Systolic or diastolic CT image acquisition for transcatheter aortic valve replacement – An outcome analysis

  • Author Footnotes
    1 First authors contributed equally to this work.
    Julius Steffen
    Footnotes
    1 First authors contributed equally to this work.
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
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  • Author Footnotes
    1 First authors contributed equally to this work.
    Markus Beckmann
    Footnotes
    1 First authors contributed equally to this work.
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Magda Haum
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
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  • Julius Fischer
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • David Andreae
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Mathias Orban
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
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  • Konstatinos Rizas
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
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  • Daniel Braun
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Martin Orban
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Adrian Curta
    Affiliations
    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany

    Department of Radiology, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Christian Hagl
    Affiliations
    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany

    Department of Heart Surgery, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Hans D. Theiss
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
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  • Julinda Mehilli
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
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  • Steffen Massberg
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
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  • Author Footnotes
    2 Last authors contributed equally to this work.
    Simon Deseive
    Correspondence
    Corresponding author. Department of Medicine I, Klinikum der LMU München, Marchioninistr. 15, D-81377 Munich, Germany.
    Footnotes
    2 Last authors contributed equally to this work.
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
    Search for articles by this author
  • Author Footnotes
    2 Last authors contributed equally to this work.
    Jörg Hausleiter
    Footnotes
    2 Last authors contributed equally to this work.
    Affiliations
    Department of Medicine I, Klinikum der LMU München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Munich, Germany
    Search for articles by this author
  • Author Footnotes
    1 First authors contributed equally to this work.
    2 Last authors contributed equally to this work.

      Abstract

      Background

      Computed tomography (CT) imaging is the standard of care before transcatheter aortic valve replacement (TAVR). The aortic annulus undergoes conformational changes during the heart cycle. Therefore, the image acquisition time point can impact prosthesis sizing and fit. Clinical outcome data are lacking. The aim of this study was to compare systolic and diastolic cardiac CT data acquisition with regard to procedural and clinical outcomes in patients undergoing TAVR for severe aortic stenosis (AS).

      Methods

      Preprocedural high-pitch helical CT datasets were analyzed in 1954 patients undergoing TAVR between 2013 and 2018 ​at our center. Patients were stratified into two groups according to the acquisition heart phase (979 systolic and 975 diastolic). The study was approved by the local ethics committee.

      Results

      Median age was 81.6 [interquartile range 77.5–85.8] years and 964 (49.3%) patients were male. No significant difference was found for the Valve Academic Research Consortium-3 (VARC-3) endpoints of technical failure (systolic, 5.1% vs. diastolic, 5.2%, p ​= ​0.94) or device failure (systolic, 13.7% vs. diastolic, 13.5%, p ​= ​0.92). There was no difference in paravalvular regurgitation. All-cause 30-day mortality was comparable (systolic, 3.6% [95% confidence interval, 2.4–4.7%] vs. diastolic, 3.6% [2.4–4.8%], p ​= ​1.00), while 3-year mortality rates were higher in the diastolic group (Society of Thoracic Surgeons score adjusted hazard ratio, 1.25 [1.07–1.46], p ​< ​0.01).

      Conclusions

      While the 30-day technical and clinical outcomes after TAVR are comparable between systolic and diastolic CT imaging, diastolic imaging was associated with higher long-term mortality. Therefore, the data support the guideline recommendation of systolic imaging.

      Graphical abstract

      Keywords

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