Effect of body mass index on the image quality of rotational angiography without rapid pacing for planning of transcatheter aortic valve implantation: A comparison with multislice computed tomography

Aims To evaluate the feasibility of procedural planning for transcatheter aortic valve implantation (TAVI) using rotational angiography (R-angio) by comparison with multislice computed tomography (MSCT) and to investigate determinants of the image quality of R-angio.Methods and results Patients who underwent R-angio of the left ventricle and cardiac MSCT were eligible. R-angio acquisition was performed during contrast injection through a 6F pigtail catheter positioned in the left ventricle. On 3D R-angio and MSCT data sets, diameter measurements were made on short-axis images at the level of the aortic annulus (D_perimeter, D_area), ascending aorta, sino-tubular junction (ST-junction), and the sinus of Valsalva. At the level of the aortic annulus, diagnostic image quality was obtained in 49 of 56 patients. In all patients with a body mass index (BMI) < 29 kg/m², image quality was acceptable whether or not rapid pacing was used. In patients with BMI ≥ 29 kg/m², the image quality was poor in 1 of 9 (11%) who were rapidly paced compared with 6 of 12 (50%) who were not. The correlation between R-angio and MSCT measurements was high for aortic annulus D_perimeter, D _area, ST-junction, Valsalva sinus, and ascending aorta (respectively, R = 0.90, 0.90, 0.91, 0.92, and 0.89). The correlations improved further when the analysis was limited to patients with a BMI < 29 kg/m² (respectively, 0.92, 0.92, 0.92, 0.92, and 0.93).Conclusion R-angio of the left ventricle allows precise measurement of the aortic root and annulus and was feasible for sizing at the time of TAVI. Diagnostic image quality was obtained without rapid pacing in all patients with a BMI < 29 kg/m².