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12,13 Furthermore, a pmIF with unclear significance could influence the decision of the heart team since TAVR guidelines do not recommend intervention in patients with an estimated survival below 1 year.7 The diagnostic workup triggered by the pmIF could delay intervention on the aortic valve and thus could raise mortality in patients with severe aortic valve stenosis,1,5,14 and the burden of symptoms of aortic valve stenosis limits quality of life of patients when an intervention with a fast recovery could be performed. It is unknown whether the presence of suspicious pmIF with an estimated patient survival of >1 year correlates with mortality in elderly patients planned for aortic valve replacement. Therefore, the purpose of this systematic retrospective observational study is to evaluate the prevalence and relevance of potentially malignant unsuspected pmIF with respect to treatment decision, time to treatment, and 2-year survival. Quinapyramine Methods Study design The study is a retrospective, single-centre Selleckchem GDC 0449 observational study in 414 participants who underwent CT for evaluation of TAVR between October 2010 and December 2012 at the University Heart Center Freiburg. Only patients with severe aortic valve stenosis were included for further analyses. Participants were retrospectively screened for pmIF, which were suspicious for malignancy as assessed by a senior radiologist. An interdisciplinary heart team consisting of cardiologist, heart surgeon, and radiologist made the decision for conservative, best medical therapy only (drug therapy), or invasive treatment, i.e. SAVR or TAVR. The follow-up period ended at January 2014. All participants gave informed consent. The ethical committee of the University of Freiburg approved the study design, and the study complies with the Declaration of Helsinki. Pre-procedural dual-source CT scanner All examinations were performed on a first-generation dual-source CT scanner (DSCT, Somatom MS-275 order Definition, Siemens Healthcare) using the following scan parameters: 330 ms gantry rotation time, detector collimation 0.6 mm, and tube voltage of 120 kV. A scout view of thorax and abdomen was obtained to plan data acquisitions. After a single contrast medium injection, combined ECG-assisted scanning of the thorax and the upper chest (including 2�C3 cm of the arteria carotis), and non-ECG-assisted scanning of the abdomen were performed. The total amount of contrast agent (Imeron 350?, Bracco, Konstanz, Germany) and flow rate were adapted to body weight: patients weighing