Abstract 17582: Incidence, Significance, and Financial Impact of Non-Cardiac Incidental Findings Identified on CT Angiography Performed Prior to Transcatheter Aortic Valve Replacement (TAVR)

Abstract

Background: CT angiography of the aorta is now performed as part of the work-up for Transcatheter Aortic Valve Replacement (TAVR). We sought to determine the incidence, clinical significance, and potential financial impact of non-cardiovascular incidental findings (IF) identified on CT performed prior to TAVR.

Methods: Of 102 consecutive patients referred for possible TAVR, 80 underwent CT. After full field of view reconstruction, non-cardiac structures were evaluated by two radiologists. IFs were diagnosed where an abnormality was found without previous clinical suspicion or known disease, and were categorised either as clinically significant (CS, when findings were clearly pathological and/or diagnostic), indeterminate (when additional investigations were required to clarify diagnosis), or clinically insignificant (CI). Cost analysis was performed using UK Government Department of Health figures (2011-2012 financial year). Costs were defined as the sum of direct medical costs incurred as a result of investigating the IF, excluding any subsequent treatment required.

Results: Of the 80 patients studied (51% male, mean age 77.4 years), 67/80 (84%) had IFs. 19/80 patients (24%) had CS findings, 24/80 (30%) had indeterminate findings, and 24/80 (30%) had CI findings. A total of 55 IFs were deemed CS or indeterminate, the majority of which were pulmonary (29/55, 53%; figure). Of the 19 CS findings, eight were probable malignancies of the pulmonary and urological systems. The total cost associated with the subsequent investigation of CS and indeterminate findings was £15,363 (figure).

Conclusions: The vast majority of patients undergoing CT angiography of the aorta prior to TAVR have incidental non-cardiac findings, the majority of which will require further investigation. In addition to their clinical significance, incidental findings incur added expense that must be considered when evaluating the cost-effectiveness of TAVR.