This study aims to evaluate the clinical value of a novel CT gantry supporting a .23 second rotation time and systematically compare it with 0.23 second rotation time, in patients with clinically indicated aortic CTA in the workup of aortic stenosis. Patients will be randomly assigned .23 or .28 sec rotation time CTA. Coronary artery interpretability rates will be determined in both groups.
Coronary artery analysis is an essential component of cardiac CT, but is often challenging without beta-blocker use. CT's technological advances are continuously evolving, paving the way for safer and more accurate diagnoses. Part of these innovations is the development of faster rotation speeds (0.23 sec/rotation), which is expected to allow for heart rate-independent CCTA. Patients subjected to aortic stenosis workup routinely undergo invasive coronary angiography (ICA) in the catheterization laboratory, voiding the need to control the heart rate at the time of cardiac CT because aortic valve measurements can be performed even at higher heart rate. Still, cardiac CT in this context is performed with ECG-gating, and attempting to evaluate coronary arteries is possible without interfering with clinical decisions. Also, the existing literature advocates the use of gantry rotation speeds of at least 0.5 sec/rotation; consequently, the use of 0.28 versus 0.23 sec/rotation for this study will comply with current guidelines and will have no detrimental impact on patient management. This study aims to evaluate coronary artery interpretability in patients subjected to cardiac CT for the anatomical assessment of aortic valve stenosis prior to endovascular (transcatheter aortic valve implantation \[TAVI\]) or surgical therapy. Patients will be enrolled after providing written, informed consent, and will be randomly assigned either to the test (0.23 sec rotation time) or control group (0.28 sec rotation). The participants concerned are not subjected to any additional invasive or stressful procedure compared with those undergoing aortic stenosis workup in clinical routine.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
Aortic CTA performed with short (0.23 sec) gantry rotation time.
Aortic CTA performed with standard (.28 sec) gantry rotation time.
Lausanne University Hospital (CHUV)
Lausanne, Switzerland
RECRUITINGInterpretable CTA rate per patient
Number of patients with diagnostic image quality for coronary artery disease
Time frame: Up to 90 days
Interpretable CTA rate, per segment
Number of segments with diagnostic image quality for coronary artery disease
Time frame: Up to 90 days
CTA performance to measure diameter stenosis, using invasive coronary angiography as gold standard
CTA's diagnostic accuracy for coronary occlusive disease
Time frame: Coronary angiography performed withing 30 days of CTA
Relationship between heart rate and non-diagnostic CTA
Correlation between of heart rate (in BPM) and the presence of any uninterpretable coronary segment on CTA
Time frame: Up to 90 days
Quantitative image quality (contrast to noise ratio)
Comparison of contrast to noise ratio between both groups
Time frame: Up to 90 days
Radiation dose per patient
Effective dose (mSv) comparison between both groups
Time frame: Up to 90 days
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DOUBLE
Enrollment
124