2023-10-16 09:01:10
New option for planning heart valve interventions
Computed tomography (CT) has proven useful in preparing for procedures such as transcatheter aortic valve replacement (TAVI). However, almost half of patients with acquired narrowing of the heart valves suffer from chronic kidney disease, which speaks once morest the use of CT contrast agents. A randomized study has now proven for the first time that cardiac magnetic resonance imaging is also suitable for TAVI planning – a ray of hope for a more gentle TAVI diagnosis.
To correct acquired narrowing of the heart valves (aortic valve stenosis), percutaneous minimally invasive implantation of an artificial aortic valve using a catheter (TAVI) is increasingly being used.
The pre-interventional planning of the procedure is usually carried out using computer tomography (CT), which, however, represents a significant limitation for patients with renal insufficiency due to the required use of iodine-containing contrast medium. “Around half of all TAVI candidates suffer from kidney failure and are at an increased risk of kidney damage due to the use of iodine-containing contrast media during a CT scan. The radiation exposure during CT is another disadvantage, especially in light of the ever younger TAVI population,” says Sebastian Reinstadler from the Innsbruck University Clinic for Internal Medicine III (cardiology and angiology). Agnes Mayr from the Innsbruck University Clinic for Radiology adds: “Cardiac magnetic resonance imaging (CMR) offers a promising radiation-free alternative, but so far there has been a lack of randomized data comparing the suitability of CMR- and CT-guided TAVI.”
Caption: New data shows that cardiac magnetic resonance imaging has no disadvantages when planning TAVI. (c) Cardiology Innsbruck
In a new one recently published in the recognized journal Circulation Published study has now demonstrated for the first time that CMR is a good and clinically suitable alternative for TAVI planning. For the cooperation project between the University Clinic for Cardiology and Angiology and the University Clinic for Radiology, TAVI candidates at the heart centers in Innsbruck and Wels were randomized and assigned to CMR-guided or CT-guided TAVI planning. “In the cohort of patients who underwent TAVI, we found that CMR-guided TAVI was not inferior to CT-guided TAVI in terms of implantation success and was therefore considered as an alternative to TAVI planning can” confirms first author Martin Reindl, who was able to present these positive findings together with the cardio-MRI working group led by Bernhard Metzler at this year’s ESC Congress, the world’s leading congress in the field of cardiology, in the prominent “Late Breaking Science” session.
(October 16, 2023, text: D. Heidegger, photos: University Clinic for Internal Medicine III)
Links:
Cardiac Magnetic Resonance Imaging Versus Computed Tomography to Guide Transcatheter Aortic Valve Replacement (TAVR-CMR): A Randomized, Open-Label, Non-Inferiority Trial. Martin Reindl et al., Circulation 27 Aug 2023
https://doi.org/10.1161/CIRCULATIONAHA.123.066498
University Clinic for Internal Medicine III
University Clinic for Radiology
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