PhD Scientific Days 2026

Poster Session 2.Q - Cardiovascular Medicine and Research

Diagnostic Accuracy of UHR PCD-CT Angiography for CAD in Comparison with ICA in Patients prior TAVI – Preliminary Results from a Prospective Multicenter Registry

Name of the presenter

Beke, Sámuel

Institute/workplace of the presenter

Medical Imaging Centre, Semmelweis University

Authors

Sámuel Beke¹, Titus Tóth¹, Lili Száraz¹, Kristóf Nagy¹, Réka Sebestyén-Dósa¹, István Csulak¹, Barnabás Baksa¹, Milán Vecsey-Nagy², Bálint Szilveszter², Anikó Ilona Nagy², Tilman Emrich³, Ákos Varga-Szemes⁴, Pál Maurovich-Horvat¹
1: Medical Imaging Centre, Semmelweis University
2: Heart and Vascular Center, Semmelweis University
3: Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University
4: Department of Radiology and Radiological Science, Medical University of South Carolina

Text of the abstract

Introduction: The old and fragile population of patients referred to transcatheter aortic valve implantation (TAVI) has high pretest probability of coronary artery disease (CAD), therefore the assessment of the coronary arteries prior TAVI is recommended with invasive coronary angiography (ICA). The TAVI planning CT angiography may be suitable for diagnosing CAD using ultrahigh-resolution (UHR) photon-counting detector CT (PCD-CT) with high spatial and temporal resolution.

Aims: To determine the diagnostic accuracy of UHR PCD-CT angiography in comparison with ICA for detecting CAD in patients prior TAVI.

Method: Patients prior TAVI were prospectively enrolled in a multicenter registry. PCD-CT scans from one center were analyzed, if ICA within 90 days was available. Patients with prior revascularization were excluded. Highest stenosis grade (<50%, 50–69%, 70–99%, 100%) per vessel (LAD, LCX, RCA) and CAD-RADS score were determined by a single reader. In case of non-diagnostic image quality (CAD-RADS N), ≥70% stenosis was assumed. The written reports of ICA served as reference. Sensitivity, specificity, accuracy and area under the ROC curve (AUC) were calculated.

Results: 207 coronary arteries from 69 patients (80±5 years, 51% male) were evaluated. 6 scans (8%) were non-diagnostic (CAD-RADS N). Obstructive (≥50%) stenosis was found in 51 vessels (25%), severe (≥70%) stenosis was found in 27 vessels (13%). For detecting CAD-RADS ≥3 and CAD-RADS ≥4 disease, the sensitivity, specificity, and accuracy were 89%, 86%, 87% and 88%, 90% and 90%; the AUC values were 0.876 (0.775 – 0.977) and 0.888 (0.748 – 1.029), respectively. The CAD-RADS score was reclassified in 12 patients (17%), including non-diagnostic scans. At vessel level, for detecting ≥50% and ≥70% stenosis, the sensitivity, specificity, and accuracy were 84%, 84%, 84% and 75%, 91%, 90%; the AUC values were 0.838 (0.749 – 0.926) and 0.829 (0.683 – 0.975), respectively.

Conclusion: UHR PCD-CT angiography detects obstructive and severe CAD with high accuracy prior TAVI, and may serve as an alternative to ICA in high pretest probability patient groups.

Funding: SE250+