In either case, less invasive imaging via contrast-enhanced coronary CT angiography is in- creasingly adopted. Recommendation-Specific Supportive Text 1. CAD is frequently present among patients with and may contribute to angina pecto- ris among those with aortic valve disease.3,4 Knowledge of coronary anatomy contributes to risk stratification, in addition to directing concom- itant coronary revascularization. There is a very low prevalence of CAD among men <40 years of age and premenopausal women with no athero- sclerotic risk factors2,5 7 or history of mediastinal 2. Functional MR occurs in patients with structur- ally normal valve leaflets and chordae because of LV dysfunction, including regional wall motion abnormalities or global dilation with displace- ment of the papillary muscles, leaflet tethering, annular dilation, and decreased closing forces from reduced contractility.9 11 Because this LV dys- function may be attributable to CAD and accom- panying myocardial ischemia, the assessment of coronary anatomy status is necessary to complete the diagnosis and allow evaluation of revascular- ization options. 3. Contrast-enhanced coronary CT angiography is an alternative to coronary angiography among selected patients who are at low to intermediate pretest probability of CAD before valve surgery.12 This does not include patients who have active symptoms of angina, those with documented ischemia, or those with a prior history of CAD, all of whom should have selective coronary angi- ography. Recent studies, most often in the set- ting of a pre-TAVI evaluation, have demonstrated diagnostic sensitivity of >90%, specificity of 60% and accuracy of >90%.21 Contrast- enhanced coronary CT angiography may be safer than coronary angiography in selected patient populations, such as those with IE and vegeta- tions on the aortic valve. 