Abstract
Introduction
Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic
angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral
approach, although many candidates being considered for TAVR are at increased risk
of contrast-induced nephropathy (CIN).
Objective
To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians
and nonagenarians at risk of CIN.
Approach
We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who
underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33). We compared clinical characteristics, CTA image quality (score 1–4) and interpretability,
and clinical outcomes, including CIN and vascular complications.
Results
The mean age was 88.5±4.0 years, 37% were male, and chronic renal insufficiency was
common in both the standard and low-dose contrast cohorts (57% vs. 70%, P=.39). The low-dose contrast protocol was associated with a significantly less contrast
volume compared to standard contrast protocol (127±18 ml vs 76±55 ml, P<.001). Individuals imaged using low-dose (n=16) versus standard (n=17) contrast protocols received 80% less contrast volume (23±10 vs. 125±23 ml, P<.001). There was similar graded image quality (3.8±0.4 vs. 3.9±0.3, P=.76) and interpretability (100% for each, P=1.0) between standard and low-dose contrast protocol groups. There was no significant
difference in rates of CIN after CTA between standard and low-dose contrast protocol
groups (10% vs. 3%, P=.55), with no CIN events in those imaged by low-dose CTA. There were no major vascular
injuries associated with TAVR or pigtail insertion, no major bleeding for CTA, and
no noninterpretable studies in all patients.
Conclusion
In this proof-of-principle study, a low-dose contrast protocol appears feasible and
safe in octogenarians and nonagenarians undergoing screening for TAVR, and results
in significant reduction in contrast load as compared to a standard contrast protocol
without observed differences in image quality or safety.
Abbreviations:
TAVR (transcatheter aortic valve replacement), CTA (computed tomography angiography), T-CTA (traditional CTA), CIN (contrast-induce nephropathy), GFR (glomerular filtration rate), CRI (chronic renal insufficiency)Keywords
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Article info
Publication history
Published online: October 14, 2014
Accepted:
August 8,
2014
Received in revised form:
July 29,
2014
Received:
March 21,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
