Clinical value of computed tomography in suspected prosthetic valve dysfunction

BACKGROUND: Prosthetic valve dysfunction (PVD) is potentially life-threatening, yet often challenging to diagnose. We aimed to determine the negative and positive predictive value (NPV, PPV) of cardiac computed tomography (CT) in clinically suspected PVD. METHODS: Consecutive patients with prosthetic heart valves (PHVs), who underwent clinically indicated CT for suspected PVD between January 2017 and June 2024, were retrospectively assessed. CT scans with adequate image quality were evaluated and classified (abnormal: periprosthetic masses; structural valve deterioration (SVD); restricted leaflet motion). Valve-related adverse events and follow-up imaging were assessed to evaluate the diagnostic performance. RESULTS: Of all 64 patients (58.6 ± 16.9 years, 42.2% female), 68.8% had mechanical, 18.8% bioprosthetic, and 12.5% transcatheter PHV. CT findings were normal in 34 (53.1%) patients, with an NPV of 94% for ruling out device-related adverse events within a follow-up of 1 year. Among 30 (46.9%) patients with abnormal CT findings, a periprosthetic mass was identified in 21 (70%), including pannus (n = 10), thrombus (n = 6), vegetations (n = 3). SVD was observed in 2 patients (6.7%). Among 23 patients with mechanical PHVs, 18 (78.3%) exhibited restricted leaflet motion. Surgical interventions confirmed CT abnormalities in 7/10 patients, yielding a 70% PPV. CONCLUSION: This study is the first to demonstrate the high negative predictive value of CT for ruling out significant PVD-related complications, reinforcing its role as a reliable modality for ruling out major adverse events. While the PPV for identifying underlying PVD pathologies was moderate, CT effectively identified structural abnormalities that required intervention, supporting its clinical usefulness for comprehensive assessment of suspected PVD.