Computed tomography imaging for subclinical leaflet thrombosis following surgical and transcatheter aortic valve replacementSubclinical leaflet thrombosis (LT) may occur following surgical and transcatheter aortic valve replacement. Computed tomography (CT) has become an established imaging modality to diagnose subclinical LT following bioprosthetic aortic valve replacement. Even so, there is a limited (but growing) experience in utilizing CT imaging for this indication. This review emphasizes a systematic approach to acquiring and analysing CT imaging for subclinical LT, highlighting evidence surrounding clinical sequelae of subclinical LT and anti-thrombotic implications following diagnosis.
Systolic or diastolic CT image acquisition for transcatheter aortic valve replacement – An outcome analysisComputed 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).
The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement186 patients were prospectively recruited following transcatheter aortic valve replacement (TAVR) for hypo-attenuated leaflet thickening (HALT) on computed-tomography (CT) imaging and to determine its impact on haemodynamic valve deterioration (HVD). Routine echocardiograms at discharge, one month and annually were performed. LT prevalence was 17.7% and HVD was present in 8.6% of the total cohort. HALT was the only independent predictor of HVD. Thresholds for HALT predicting HVD were a cumulative depth of 2.4 mm and cumulative area of 28 mm2. HALT is an independent predictor of HVD, which exhibits specific depth and area thresholds for HVD prediction.
Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacementTOC summary: This study evaluated the presence of right ventricular dysfunction (RVD) by functional cardiac computed tomography angiography (CCTA) in 502 patients undergoing routine evaluation for transcatheter aortic valve replacement. CCTA-RVD was defined as right ventricular ejection fraction <50%, and was tested for its prognostic value beyond conventional risk factors and echocardiography. In our study, 25% of patients have RVD on CT that was not present on 2D echocardiography. CT-RVD provides independent prognostic value that is incremental to conventional clinical and echocardiographic characteristics, and therefore should be considered in routine risk stratification of patients with severe AS.
Multi-modality imaging and operative findings of a post-TAVR ventricular septal defectMichael Morris: Consultant for Edwards Lifesciences. Educational training for Medtronic.
Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve diseaseCT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.
Accelerating the future of cardiac CT: Social media as sine qua non?The vision for the Journal of Cardiovascular Computed Tomography's social media efforts is to amplify the impact of the Journal while driving engagement, increasing journal visibility and disseminating content to new audiences globally. Serving as “the front door” to the Journal, this digital evolution represents an important step forward for a field in which advancements in hardware, image processing and clinical evidence have evolved rapidly. However, is social media the panem et circenses of cardiovascular computed tomography (CT), that of superficial appeasement, or of sine qua non; an essential ingredient to the acceleration of the Journal and of the field of cardiovascular CT? This paper aims to present the initial impact of social media within a dedicated cardiovascular CT journal.
Baseline global longitudinal strain by computed tomography is associated with post transcatheter aortic valve replacement outcomesComputed tomography angiography derived global longitudinal strain (CTA-GLS) has been shown to be feasible, however its prognostic value remains unclear in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). We evaluated the association of baseline CTA-GLS with outcomes including all-cause mortality and composite endpoint of death and heart failure hospitalization in 223 patients treated with TAVR. Patients with normal LVEF but reduced CTA-GLS had similar event rate to those with impaired LVEF, and higher than those with normal LVEF and preserved CTA-GLS. Baseline CTA-GLS assessment might be helpful in patients with difficult echocardiographic images undergoing TAVR evaluation.
Multimodality imaging of multivalvular endocarditis after transcatheter aortic valve replacementTranscatheter aortic valve replacement (TAVR) has emerged as an alternative to surgery for severe aortic stenosis in non-operable and high surgical risk patients. While endocarditis following TAVR is rare, the significant co-morbidities commonly found in this patient population can complicate evaluation and management. A case of TAVR endocarditis initially diagnosed by cardiac computed tomography angiography and confirmed with transesophageal echocardiogram is presented. In addition to demonstrating the appearance of vegetations and perivalvular involvement in endocarditis complicating TAVR, this case illustrates the utility of cardiac CT techniques in imaging suspected TAVR endocarditis.