EACVI Survey: The Use of CTCA and Multimodality Imaging for PCI Planning and Structural Heart Interventions

We invite you to take part in this EACVI survey exploring how cardiac CT – particularly CT coronary angiography (CTCA) – is currently used to guide PCI and structural heart interventions across European centres. This brief questionnaire aims at benchmarking real-world practice against recent international consensus recommendations, capturing institutional characteristics, availability of CT and post-processing tools, patterns of use in complex PCI and structural programmes, and the structure of Heart Team collaboration between imagers and interventional cardiologists.
By sharing your centre’s experience, you will help us identify gaps in access, training and workflow, inform future EACVI guidance, and shape targeted educational and implementation initiatives to support high-quality, imaging-led interventional care throughout Europe.

May we remind you of the codes of conduct related to market research among healthcare professionals:
· The survey is anonymous
· You have the right to end your participation in this survey at any time
· We comply with the European General Data Protection Regulation (GDPR) 2016/679. Any personal data processed in connection with this survey will be treated confidentially and only used for the purposes of market research. Material and data collected from you will be analysed overall, used internally by the ESC and kept for a maximum of 24 months for analysis and quality control purposes. We take all reasonable care to prevent any unauthorised access to your personal data. We respect your privacy and your right to access, modify, or suppress your personal data. At any time, you can ask to know what personal data is being held. If you have any questions about data protection or require further information, please contact our data protection officer DPO@escardio.org

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* 1. May we please ask you to confirm you have read the clauses above and accept participation in this survey?

Yes

Demographics

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* 2. What is your current role?

Interventional cardiologist

Imaging cardiologist

General cardiologist

Radiologist

Fellow or trainee

Other (please specify)

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* 3. Which country do you work in?

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* 4. What is your place of practice?

University/teaching hospital

General hospital

Community hospital

Private clinic

Other (please specify)

Question Title

* 5. What is the annual volume of PCI at your centre?

<200

200–999

1,000–1,999

≥2,000

Not sure

Question Title

* 6. What are the imaging modalities available in your department/hospital?
Select all that apply.

Transthoracic echocardiography (TTE)

3-dimensional (3D) TTE

Transoesophageal echocardiography (TOE)

Intracardiac echocardiography (ICE)

Computed tomography (CT) coronary angiography

Photon counting CT

CT perfusion

CT-Fractional flow reserve (FFR)

Cardiac Magnetic Resonance (CMR)

Positron Emission Tomography (PET) and Computed Tomography (PET/CT0

Single Photon Emission Computed Tomography (SPECT)

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* 7. What is the number of accredited coronary CT readers at your centre?

1–3

Not sure

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* 8. What are the CT reader accreditation types at your centre?

EACVI level 2/3

SCCT level 2/3

National equivalent

None

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* 9. Please select the structural heart procedures performed on site.
Select all that apply.

ASD /PFO closure

LAAC

TAVI

TEER

TMVR

TTVI

Referring to larger centre

Current practice

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* 10. What is the first-line test for evaluating patients with stable chest pain in your clinical practice?

Exercise ECG

Stress Echo

Stress CMR

SPECT

PET

CTCA

Invasive angiography

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* 11. What is the main clinical reason your team chooses CTCA over functional testing as the first-line test in stable chest pain?

Rule-out of CAD in low/intermediate risk (as per clinical guidelines)

Better anatomical definition needed

Pre-PCI anatomical planning

Equivocal/non-diagnostic prior functional test

Local preference or access considerations

Other/specify

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* 12. Please select the CT planning software/capabilities available at your centre.

PCI — Coronary centreline and quantitative vessel sizing

PCI — Plaque characterisation (calcified/non-calcified) and stenosis quantification

PCI — Calcium blooming/artifact reduction tool

PCI — Lesion length and stent sizing (landing-zone planning)

PCI — Bifurcation planning with 3D reconstructions

PCI — CTO pathway analysis tools

PCI — CT-derived physiology (FFR-CT)

PCI — CT perfusion

Structural — TAVI annulus/LVOT/aortic root sizing and coronary height

Structural — Ilio-femoral access planning

Structural — Valve-in-valve planning library

Structural — LAAC device sizing and landing zone assessment

Structural — Mitral TEER planning (leaflet grasping, coaptation anatomy)

Structural — TMVR planning (neo-LVOT prediction/simulation)

Structural — Tricuspid repair/replacement planning

Structural — CT-to-fluoro/echo fusion or 3D model export to cath lab

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* 13. How often was CT used for PCI planning in the last 12 months?

Not used

<10% of applicable cases

10-50%

>50%

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* 14. What are the indications for CT-guided PCI?
Select all that apply.

C-arm angulations

Left main disease

Bifurcations

CTO

Heavily calcified lesions/stented segments

Virtual stenting (CT-FFR)

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* 15. When CT is used for PCI/structural planning, who reviews the outputs?
Select all that apply.

Interventional cardiologist

Imaging cardiologist

Radiologist

Joint reporting by cardiologist and radiologist

Trained technologist

Industry or outsourced core lab

Discussed during MDT/Heart team meetings

No formal review meeting

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* 16. If CT is NOT used routinely for PCI planning, what are the main reasons?
Select up to 3

Reimbursement absent/unclear

No trained readers or post-processing staff

Preference for invasive angiography

CT access/reporting too slow

Image quality concerns (calcification, stents)

Software/tools lacking

Belief CT seldom alters plan

Patient factors (AF, CKD, BMI)

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* 17. How often is pre-procedural CT used for structural interventions?
Select one per row

	Routinely	Rarely	Not available on site
PFO/ASD	PFO/ASD Routinely	PFO/ASD Rarely	PFO/ASD Not available on site
TAVI	TAVI Routinely	TAVI Rarely	TAVI Not available on site
LAAC	LAAC Routinely	LAAC Rarely	LAAC Not available on site
TEER	TEER Routinely	TEER Rarely	TEER Not available on site
TMVR	TMVR Routinely	TMVR Rarely	TMVR Not available on site
TTVI	TTVI Routinely	TTVI Rarely	TTVI Not available on site

Question Title

* 18. How often is intra-procedural TTE/TOE used for structural interventions?
Select one per row

	Routinely	Rarely	Not available on site
PFO/ASD	PFO/ASD Routinely	PFO/ASD Rarely	PFO/ASD Not available on site
TAVI	TAVI Routinely	TAVI Rarely	TAVI Not available on site
LAAC	LAAC Routinely	LAAC Rarely	LAAC Not available on site
TEER	TEER Routinely	TEER Rarely	TEER Not available on site
TMVR	TMVR Routinely	TMVR Rarely	TMVR Not available on site
TTVI	TTVI Routinely	TTVI Rarely	TTVI Not available on site

Question Title

* 19. Which of the multimodality imaging in clinical pathways below do you use when managing structural heart disease cases?
Select all that apply.

Echo for triage

TTE for intraprocedural guidance

TOE for intraprocedural guidance

ICE for intraprocedural guidance

CMR for viability/ischemia pre-revascularisation

CMR for valve assessment

None routinely

Drivers, barriers, economics

Question Title

* 20. When both CT and invasive angiography are feasible, please select the top reasons you would proceed with invasive first.
Select up to 3.

Same-day diagnosis and treatment in cath lab

Culture–habit of referrers

Payment incentivises the invasive route

Previous coronary angiography

History of previous stent implantation

CT slots or reporting turnaround is too slow

Belief CT adds little to the plan

Confidence gap for complex anatomy

Patient selection issues (AF, CKD, BMI)

Question Title

* 21. Are these operational barriers at your centre?

	Yes	No	N/A
Scanner access/slots	Scanner access/slots Yes	Scanner access/slots No	Scanner access/slots N/A
Reporting capacity	Reporting capacity Yes	Reporting capacity No	Reporting capacity N/A
Post-processing time	Post-processing time Yes	Post-processing time No	Post-processing time N/A
Software/licensing costs	Software/licensing costs Yes	Software/licensing costs No	Software/licensing costs N/A
Data integration/PACS	Data integration/PACS Yes	Data integration/PACS No	Data integration/PACS N/A
Heart-team culture/acceptance	Heart-team culture/acceptance Yes	Heart-team culture/acceptance No	Heart-team culture/acceptance N/A
Patient factors (HR, CKD, BMI)	Patient factors (HR, CKD, BMI) Yes	Patient factors (HR, CKD, BMI) No	Patient factors (HR, CKD, BMI) N/A
Reimbursement clarity	Reimbursement clarity Yes	Reimbursement clarity No	Reimbursement clarity N/A

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* 22. What is the typical turnaround time betweenthe the cardiac CT and signed report for PCI/structural planning?

Same day

24–72 h

>72 h

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* 23. Do you implement the clinical guidance recommending the use of CT in PCI and structural heart disease procedure planning (EACVI/ESC/SCCT/EAPCI/local recommendation)?

No, I am not at all aware of it

No, and I am only vaguely aware of it

Yes, I am somewhat aware of it but it is not implemented locally

Yes, I am fully aware of it and it is implemented locally

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* 24. What is the meeting frequency of the Heart Team (Imaging-interventional team)?

	Weekly	Monthly	Ad hoc	Never
Meetings	Meetings Weekly	Meetings Monthly	Meetings Ad hoc	Meetings Never
Emails	Emails Weekly	Emails Monthly	Emails Ad hoc	Emails Never
Chat	Chat Weekly	Chat Monthly	Chat Ad hoc	Chat Never

Other (please specify)

Question Title

* 25. Who are the members of the Heart Team in your hospital?
Select all that apply.

General Cardiologist

Imaging Cardiologist

Invasive Cardiologist

Radiologist

Cardiothoracic surgeon

Anaesthetic consultant

Geriatrics specialist

Other (please specify)

Future and EACVI support

Question Title

* 26. From your perspective, what are the most important changes needed in the use of cardiac CT over the next 3–5 years?
Please rank the below propositions from most important to less important.

EACVI Survey: The Use of CTCA and Multimodality Imaging for PCI Planning and Structural Heart Interventions

Question Title

* 1. May we please ask you to confirm you have read the clauses above and accept participation in this survey?

Question Title

* 2. What is your current role?

Question Title

* 3. Which country do you work in?

Question Title

* 4. What is your place of practice?

Question Title

* 5. What is the annual volume of PCI at your centre?

Question Title

* 6. What are the imaging modalities available in your department/hospital?Select all that apply.

Question Title

* 7. What is the number of accredited coronary CT readers at your centre?

Question Title

* 8. What are the CT reader accreditation types at your centre?

Question Title

* 9. Please select the structural heart procedures performed on site.Select all that apply.

Question Title

* 10. What is the first-line test for evaluating patients with stable chest pain in your clinical practice?

Question Title

* 11. What is the main clinical reason your team chooses CTCA over functional testing as the first-line test in stable chest pain?

Question Title

* 12. Please select the CT planning software/capabilities available at your centre.

Question Title

* 13. How often was CT used for PCI planning in the last 12 months?

Question Title

* 14. What are the indications for CT-guided PCI?Select all that apply.

Question Title

* 15. When CT is used for PCI/structural planning, who reviews the outputs?Select all that apply.

Question Title

* 16. If CT is NOT used routinely for PCI planning, what are the main reasons?Select up to 3

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* 17. How often is pre-procedural CT used for structural interventions?Select one per row

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* 18. How often is intra-procedural TTE/TOE used for structural interventions?Select one per row

Question Title

* 19. Which of the multimodality imaging in clinical pathways below do you use when managing structural heart disease cases?Select all that apply.

Question Title

* 20. When both CT and invasive angiography are feasible, please select the top reasons you would proceed with invasive first.Select up to 3.

Question Title

* 21. Are these operational barriers at your centre?

Question Title

* 22. What is the typical turnaround time betweenthe the cardiac CT and signed report for PCI/structural planning?

Question Title

* 23. Do you implement the clinical guidance recommending the use of CT in PCI and structural heart disease procedure planning (EACVI/ESC/SCCT/EAPCI/local recommendation)?

Question Title

* 24. What is the meeting frequency of the Heart Team (Imaging-interventional team)?

Question Title

* 25. Who are the members of the Heart Team in your hospital?Select all that apply.

Question Title

* 26. From your perspective, what are the most important changes needed in the use of cardiac CT over the next 3–5 years? Please rank the below propositions from most important to less important.

* 6. What are the imaging modalities available in your department/hospital?
Select all that apply.

* 9. Please select the structural heart procedures performed on site.
Select all that apply.

* 14. What are the indications for CT-guided PCI?
Select all that apply.

* 15. When CT is used for PCI/structural planning, who reviews the outputs?
Select all that apply.

* 16. If CT is NOT used routinely for PCI planning, what are the main reasons?
Select up to 3

* 17. How often is pre-procedural CT used for structural interventions?
Select one per row

* 18. How often is intra-procedural TTE/TOE used for structural interventions?
Select one per row

* 19. Which of the multimodality imaging in clinical pathways below do you use when managing structural heart disease cases?
Select all that apply.

* 20. When both CT and invasive angiography are feasible, please select the top reasons you would proceed with invasive first.
Select up to 3.

* 25. Who are the members of the Heart Team in your hospital?
Select all that apply.

* 26. From your perspective, what are the most important changes needed in the use of cardiac CT over the next 3–5 years?
Please rank the below propositions from most important to less important.