Original articleImaging Pandora's Box: Incidental Findings in Elderly Patients Evaluated for Transcatheter Aortic Valve Replacement
Section snippets
Patients
The Mayo Clinic Institutional Review Board approved this study. Consecutive patients with severe AS undergoing a TAVR-CTA scan between January 1, 2009, through January 24, 2012, were identified via the Mayo Clinic radiology database. Patients were included in this study if their imaging examination was performed as a part of an evaluation for possible TAVR regardless of whether they ultimately received TAVR, surgical aortic valve replacement (SAVR), or neither.
TAVR-CTA Scan Technique
The scan technique was created to
Patients
During the study, 424 patients underwent TAVR-CTA imaging. The median ± SD age was 82±8.3 years, and 263 patients (62.0%) were male. Intravenous contrast was withheld for medical reasons in 72 patients (17.0%). Table 1 contains information regarding associated clinical parameters and medical comorbidities. After the initial clinical evaluation, 111 patients underwent TAVR (64 transfemoral, 44 transapical, and 3 transaortic), 113 underwent SAVR, and 200 did not undergo either procedure. The mean
Discussion
The novel principal findings of this investigation are as follows: (1) PPIFs are routinely discovered in elderly patients with AS who undergo TAVR-CTA imaging (the number needed to image to diagnose a new cancer or noncancerous medical condition was 19), (2) increasing numbers of PPIFs may be predictive of poorer overall survival, (3) patient factors have been identified that are associated with higher numbers of PPIFs (reduced ejection fraction and smoking history), (4) PPIFs result in
Conclusion
Potentially pathologic incidental findings are common in elderly patients undergoing TAVR-CTA scans and, once discovered, commonly generate further clinical evaluation. Higher numbers of PPIFs may be predictive of poorer survival, but further study is required to guide the appropriateness of pursuing diagnostic evaluations for asymptomatic PPIFs in this elderly population.
Acknowledgments
Statistical analysis was performed in direct consultation and collaboration with the biostatisticians at the Service Center of the Mayo Clinic Translational Science Activities. We thank the biostatisticians for their assistance. We also thank the Rochester Epidemiology Project8 for use of its Minnesota death certificate database and Drs Rajiv Gulati and Daniel B. Spoon for use of the Mayo Clinic percutaneous coronary intervention mortality database.
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Cited by (16)
Outcomes of Patients Undergoing Transcatheter Aortic Valve Implantation With Incidentally Discovered Masses on Computed Tomography
2020, American Journal of CardiologyPrevalence and consequences of noncardiac incidental findings on preprocedural imaging in the workup for transcatheter aortic valve implantation, renal sympathetic denervation, or MitraClip implantation
2018, American Heart JournalCitation Excerpt :Instead, renal insufficiency and COPD at baseline appeared to be the sole independent predictors for 1-year mortality. Previous work by Orme et al concluded that a higher number of potentially pathological IF per patient might impact 2-year mortality in 424 patients screened for TAVI.15 In the subgroup of patients from our study that were screened for TAVI (n = 782), we were not able to confirm that the number of moderate or major IF per patient significantly predicts 1-year mortality.
Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation
2017, American Journal of CardiologyCitation Excerpt :To the best of our knowledge, this is the largest study on incidental findings in TAVI work-up with a follow-up of up to 5 years specifically after TAVI. Previous studies published conflicting results on short- and mid-term impact of incidental findings.8–11 In contrast to the current study, these reports focused on evaluation of survival after CTA and not specifically after TAVI.
Incidental findings in medical imaging and genetic testing: Opportunities and challenges
2014, Mayo Clinic Proceedings