Abstract 16405: Does the Reduction of Contrast Medium Jeopardize the Accuracy of Access Vessel Measurements in TAVR Candidates With Chronic Kidney Disease?
Background: CTA with reduced IV contrast medium (CM) has been advocated for TAVR candidates with chronic kidney disease (CKD). The impact of necessarily reduced image quality and the prevalence of post-CTA acute kidney injury (AKI) has not been thoroughly studied.
Hypothesis: We hypothesize that an eGFR-based low CM protocol implemented on a third-generation dual-source CT (DSCT) is safe, and maintains the measurement reproduciblity in TAVR candidates with CKD.
Methods: Twenty-one TAVR candidates with CKD (SCr>1.5mg/dL) underwent an eGFR and weight based low CM DSCT protocol between July ’15 and June’16. Subjective and objective IQ (Likert-scale: 1=non-diagnostic, 4=excellent, HU, SNR and CNR) was compared to a weight, age and sex matched group undergoing a standard (std) CM protocol. Iliac vessels were measured repeatedly by 7 observers at 8 sites to establish the intra- and interobserver reproducibility (intraclass-correlation coefficient, Bland-Altman plot). Pre- and post-CT SCr and eGFR were collected and AKI assessed based on RIFLE-criteria.
Results: Mean subjective IQ was 3.3 [2-4] for low and 3.7 [3-4] for std CM DSCT. Mean HU, SNR and CNR at the external iliac arteries was 386.3±111.0, 17.3±5.1 and 15.2±5.4 for low CM and 529.7±143.3, 24.0±6.8 and 21.3±5.8 for std CM, resp. Low CM DSCT had excellent intraobserver and interobserver reliability (ICC 0.922, 0.907) and agreement for vessel diameters: mean diff. 0.04mm [-1.4-1.48] and -0.26mm [-1.76-1.24], resp. Std CM had excellent reliability (ICC 0.964 and 0.934) and agreement: -0.03mm [-0.91-0.84] and -0.09mm [-1.28-1.09], resp. Mean SCr and eGFR were available in 28 patients (19≤2days) post CT: 1.7±0.4 and 36.9±7.9 in low CM and 1.0±0.3 and 69.5±26.4 in std CM, resp. No patient had AKI based on SCr. One patient in each group fulfilled RIFLE class-I for AKI post-CT (-31%; -27% eGFR).
Conclusions: Low CM dose DSCT is safe, and maintains the reproducibility of access vessel measurements in TAVR candidates with CKD.
Author Disclosures: D. Suchá: None. L. Molvin: Speakers Bureau; Modest; General Electric. A. Kino: None. K.K. Bogart: None. S.G. Walters: None. J. Wang: None. H.C. Becker: None. D. Fleischmann: Research Grant; Modest; Siemens, General Electric. Ownership Interest; Modest; iSchemaView.
- © 2016 by American Heart Association, Inc.