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Keywords:
Cardiac, Cardiovascular system, Vascular, CT-Angiography, CT-Quantitative, Catheter arteriography, Contrast agent-intravenous, Imaging sequences, Drugs / Reactions, Toxicity, Arteriosclerosis
Authors:
A. Kino, A. S. Chin, S. Walters, W. C. Winkelmayer, W. Fearon, A. Yeung, M. Fischbein, D. C. Miller, D. Fleischmann; Stanford, CA/US
DOI:
10.1594/ecr2014/C-1231
Methods and materials
Under an Institutional Review Board approved protocol,
we performed a retrospective analysis of 145 patients undergoing TAVR.
Eleven patients (6m/5f,
mean age 85 ± 5 years) with CKD (Screatinine:1.2 ~ 4.4mg/dl ; eGFR 13.7 - 60.3 ml/min) underwent CTA with dedicated CM injection protocol based on renal function and body weight [CM volume was calculated as 2x eGFR (in mL/min/173m)] (Figure 2 and 3) and eleven patients matched for body weight that underwent a regular CM dose contrast CTA were chosen as control for qualitative and quantitative measurements.
Pre TAVR CTA image quality was assessed by 2 independent readers for annulus and aortic root for vessel sharpness/image noise using a 4 point Likert scale (1: non-diagnostic to 4:excellent) and presence of streak artifacts/calcification. Pre TAVR CTA aortic annular dimensions were also measured by 2 independent readers in the low CM dose CTAs,
and compared to a control group of weight-matched TAVR candidates who underwent the standard CM dose TAVR protocol.
Vascular opacification (HU) was measured in the aortic root and compared to a control group.
Serum creatinine/eGFR at baseline (pre CTA) and post CTA were measured and compared between standard CM dose group,
low CM dose and non CM cases.
Permanent renal damage was defined as an absolute increase of serum Cr >0.5mg/dL or 25% increase above baseline post CTA.
Serum creatinine/eGFR comparisons were carried out with paired t-test considering a statistical significance level of P < 0.05.