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Schlattmann P, Wieske V, Bressem KK, Götz T, Schuetz GM, Andreini D, Pontone G, Alkadhi H, Hausleiter J, Zimmermann E, Gerber B, Shabestari AA, Meijs MFL, Sato A, Øvrehus KA, Jenkins SMM, Knuuti J, Hamdan A, Halvorsen BA, Mendoza-Rodriguez V, Rixe J, Wan YL, Langer C, Leschka S, Martuscelli E, Ghostine S, Tardif JC, Sánchez AR, Haase R, Dewey M. The effectiveness of coronary computed tomography angiography and functional testing for the diagnosis of obstructive coronary artery disease: results from the individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT). Insights Imaging 2024; 15:208. [PMID: 39143443 PMCID: PMC11324632 DOI: 10.1186/s13244-024-01702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 08/16/2024] Open
Abstract
AIM To determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD). METHODS AND RESULTS Two-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7-96) and a specificity of 76.3% (72.2-80) compared to exercise-ECG with 54.9% (47.9-61.7) and 60.9% (53.4-66.3), SPECT with 72.9% (65-79.6) and 44.9% (36.8-53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%. CONCLUSION In patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability. SYSTEMATIC REVIEW REGISTRATION PROSPERO Database for Systematic Reviews-CRD42012002780. CRITICAL RELEVANCE STATEMENT In symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD. KEY POINTS Coronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT. The positive predictive value of coronary computed tomography angiography was ≥ 50% in patients with a clinical pretest probability of at least 10%, for ECG ≥ 40%, and for SPECT 28%. Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.
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Affiliation(s)
- Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences, and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Keno K Bressem
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Theresa Götz
- Institute of Medical Statistics, Computer Sciences, and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Georg M Schuetz
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology University Hospital Zurich, Zurich, Switzerland
| | | | - Elke Zimmermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernhard Gerber
- Department of Cardiology, Clinique Universitaire St Luc, Institut de Recherche Clinique et Expérimentale, Brussels, Belgium
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | - Ashraf Hamdan
- Department of Cardiovascular Imaging, Department of Cardiology, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Johannes Rixe
- Department of Cardiology and Electrophysiology, Jung Stilling Hospital Siegen, Siegen, Germany
| | - Yung-Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Christoph Langer
- Kardiologisch-Angiologische Praxis, Herzzentrum Bremen, Bremen, Germany
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Said Ghostine
- Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | | | | | - Robert Haase
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Coronary computed tomography versus coronary angiography for preoperative coronary assessment before valve surgery. Egypt Heart J 2021; 73:63. [PMID: 34224049 PMCID: PMC8257824 DOI: 10.1186/s43044-021-00180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Conventional coronary angiography (CAG) is currently the gold standard technique for the assessment of coronary arteries prior to cardiac valve surgery. Although CAG is a relatively safe procedure, however, it is still an invasive procedure, and it has potential hazards and complications. Coronary computed tomography angiography (CCTA) is a non-invasive technique that has emerged robustly as an excellent and attractive tool for delineating coronary anatomy. Therefore, we sought to evaluate the accuracy of CCTA when compared with the gold standard CAG in the evaluation of coronary arteries before valve surgery. We screened 111 consecutive patients with VHD undergoing a routine cardiac catheterization for preoperative evaluation of CAD. Fifty patients were eligible and underwent both CAG and CCTA. Significant coronary stenosis was defined as a luminal diameter decrease of ≥ 50%. Additionally, ectasia, calcifications, and congenital coronary anomalies were analyzed. Also, we compared both techniques regarding radiation dose, contrast volume, and complications. Non-evaluable segments were excluded from all levels of analysis. Sixty-one patients were excluded from the study due to various reasons. Results Among the 50 patients of the study population, 27 (54%) were males. The prevalence of significant CAD in the study population was 19.6% according to the patient-based analysis, and CAG could have been avoided in 80.4% of patients with a true-negative CCTA result. Diagnostic accuracy of CCTA for detection of significant stenosis was evaluated regarding sensitivity and specificity, positive predictive value, negative predictive value, and overall accuracy of CCTA, which was 87.5%, 99.6%,87.5%, 99.6%, and 99.2%, respectively, for segmental-based analysis; 86%, 100%, 100%, 99%, and 99%, respectively, for vessel-based analysis; and 77.8%,100%,100%, 94.9%, and 95.7%, respectively, for patient-based analysis. Fewer rates of complications were encountered with CCTA. Additional information obtained like calcifications and congenital anomalies was diagnosed better with CCTA than CAG. Conclusion Owing mainly to its high negative predictive value, a well-performed CCTA exam is an excellent method to rule out coronary artery disease, specially in patients who are not at high risk of atherosclerosis.
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Opolski MP, Staruch AD, Jakubczyk M, Min JK, Gransar H, Staruch M, Witkowski A, Kepka C, Kim WK, Hamm CW, Möllmann H, Achenbach S. CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery. JACC Cardiovasc Imaging 2016; 9:1059-1070. [PMID: 27344418 DOI: 10.1016/j.jcmg.2015.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022]
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4
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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5
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Pregowski J, Kepka C, Kruk M, Mintz GS, Kalinczuk L, Ciszewski M, Kochanowski L, Wolny R, Chmielak Z, Jastrzębski J, Klopotowski M, Zalewska J, Demkow M, Karcz M, Witkowski A. The clinical significance and management of patients with incomplete coronary angiography and the value of additional computed tomography coronary angiography. Int J Cardiovasc Imaging 2014; 30:825-32. [DOI: 10.1007/s10554-014-0397-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 03/04/2014] [Indexed: 01/08/2023]
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6
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Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: Comparison of accuracy, radiation dose and cost versus invasive coronary angiography. Int J Cardiol 2013; 167:2889-94. [DOI: 10.1016/j.ijcard.2012.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/29/2012] [Accepted: 07/21/2012] [Indexed: 11/21/2022]
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7
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Jenkins SMM, Johnston N, Hawkins NM, Messow CM, Shand J, Hogg KJ, Eteiba H, McKillop G, Goodfield NER, McConnachie A, Dunn FG. Limited clinical utility of CT coronary angiography in a district hospital setting. QJM 2011; 104:49-57. [PMID: 20847015 DOI: 10.1093/qjmed/hcq163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have demonstrated considerable accuracy of multi-slice CT coronary angiography (MSCT-CA) in comparison to invasive coronary angiography (I-CA) for evaluating coronary artery disease (CAD). The extent to which published MSCT-CA accuracy parameters are transferable to routine practice beyond high-volume tertiary centres is unknown. AIM To determine the accuracy of MSCT-CA for the detection of CAD in a Scottish district general hospital. DESIGN Prospective study of diagnostic accuracy. METHOD One hundred patients with suspected CAD recruited from two Glasgow hospitals underwent both MSCT-CA (Philips Brilliance 40 × 0.625 collimation, 50-200 ms temporal resolution) and I-CA. Studies were reported by independent, blinded radiologists and cardiologists and compared using the AHA 15-segment model. RESULTS Of 100 patients [55 male, 45 female, mean (SD) age 58.0 (10.7) years], 59 and 41% had low-intermediate and high pre-test probabilities of significant CAD, respectively. Mean (SD) heart rate during MSCT-CA was 68.8 (9.0) bpm. Fifty-seven per cent of patients had coronary artery calcification and 35% were obese. Patient prevalence of CAD was 38%. Per-patient sensitivity, specificity, positive and negative (NPV) predictive values for MSCT-CA were 92.1, 47.5, 52.2 and 90.6%, respectively. NPV was reduced to 75.0% in the high pre-test probability group. Specificity was compromised in patients with sub-optimally controlled heart rates, calcified arteries and elevated BMI. CONCLUSION Forty-Slice MSCT-CA has a high NPV for ruling out significant CAD when performed in a district hospital setting in patients with low-intermediate pre-test probability and minimal arterial calcification. Specificity is compromised by clinically appropriate strategies for dealing with unevaluable studies. Effective heart rate control during MSCT-CA is imperative. National guidelines should be utilized to govern patient selection and direct MSCT-CA reporter training to ensure quality control.
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Affiliation(s)
- S M M Jenkins
- Department of Cardiology, Stobhill Hospital, 133 Balornock Road, Glasgow G21 3UW, UK.
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8
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Chenot F, Montant P, Goffinet C, Pasquet A, Vancraeynest D, Coche E, Vanoverschelde JL, Gerber BL. Evaluation of Anatomic Valve Opening and Leaflet Morphology in Aortic Valve Bioprosthesis by Using Multidetector CT: Comparison with Transthoracic Echocardiography. Radiology 2010; 255:377-85. [DOI: 10.1148/radiol.0000082294] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Durst R, Bogot N, Gilon D, Drenger B. Potential role for coronary computerized angiography for assessing preoperative ischemic risk. J Cardiothorac Vasc Anesth 2010; 24:348-55. [PMID: 20149691 DOI: 10.1053/j.jvca.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Ronen Durst
- Cardiology Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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10
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Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur J Anaesthesiol 2010; 27:92-137. [DOI: 10.1097/eja.0b013e328334c017] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Guía de práctica clínica para la valoración del riesgo cardiaco preoperatorio y el manejo cardiaco perioperatorio en la cirugía no cardiaca. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73133-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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O'Gara PT. One more step for computed tomography coronary angiography before heart valve surgery. Circ Cardiovasc Imaging 2009; 2:279-81. [PMID: 19808607 DOI: 10.1161/circimaging.109.878884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OFM, Sicari R, Van den Berghe G, Vermassen F, Vanhorebeek I, Vahanian A, Auricchio A, Bax JJ, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, De Caterina R, Agewall S, Al Attar N, Andreotti F, Anker SD, Baron-Esquivias G, Berkenboom G, Chapoutot L, Cifkova R, Faggiano P, Gibbs S, Hansen HS, Iserin L, Israel CW, Kornowski R, Eizagaechevarria NM, Pepi M, Piepoli M, Priebe HJ, Scherer M, Stepinska J, Taggart D, Tubaro M. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 2009; 30:2769-812. [PMID: 19713421 DOI: 10.1093/eurheartj/ehp337] [Citation(s) in RCA: 431] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raffaele De Caterina
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Stefan Agewall
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Nawwar Al Attar
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Felicita Andreotti
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Stefan D. Anker
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Gonzalo Baron-Esquivias
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Guy Berkenboom
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Laurent Chapoutot
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Renata Cifkova
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Pompilio Faggiano
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Simon Gibbs
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Henrik Steen Hansen
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Laurence Iserin
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Carsten W. Israel
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Ran Kornowski
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | | | - Mauro Pepi
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Massimo Piepoli
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Hans Joachim Priebe
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Martin Scherer
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Janina Stepinska
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - David Taggart
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
| | - Marco Tubaro
- The disclosure forms of all the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Bettencourt N, Rocha J, Carvalho M, Leite D, Toschke AM, Melica B, Santos L, Rodrigues A, Gonçalves M, Braga P, Teixeira M, Simões L, Rajagopalan S, Gama V. Multislice Computed Tomography in the Exclusion of Coronary Artery Disease in Patients With Presurgical Valve Disease. Circ Cardiovasc Imaging 2009; 2:306-13. [DOI: 10.1161/circimaging.108.827717] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nuno Bettencourt
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - João Rocha
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Mónica Carvalho
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Daniel Leite
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Andre Michael Toschke
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Bruno Melica
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Lino Santos
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Alberto Rodrigues
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Manuel Gonçalves
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Pedro Braga
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Madalena Teixeira
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Lino Simões
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Sanjay Rajagopalan
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
| | - Vasco Gama
- From the Cardiology Department (N.B., J.R., M.C., D.L., B.M., L.S., A.R., M.G., P.B., M.T., L.S., V.G.), Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Kings College London (A.M.T.), United Kingdom; and Ohio State University (S.R.), Columbus, Ohio
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Diagnostic accuracy of MDCT coronary angiography in patients referred for heart valve surgery. Radiol Med 2009; 114:728-42. [PMID: 19484586 DOI: 10.1007/s11547-009-0403-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 11/25/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of our study was to evaluate the role of multidetector-row computed tomography (MDCT) in patients referred for heart valve surgery. We studied the diagnostic performance of CT coronary angiography (CTCA) compared with conventional coronary angiography (CCA) before valve surgery. MATERIALS AND METHODS During a 13-month period, 55 consecutive patients under evaluation for aortic (40/55) or mitral valve (15/55) disease before potential valve replacement underwent CTCA using a 64-detector-row scanner within 2 months of CCA for comparative purposes. All 17 major coronary artery segments were evaluated by one observer and compared with the reference standard. Patient-based, vessel-based and segment-based analyses of the data were performed. RESULTS Prevalence of significant coronary artery disease, defined as having at least one stenosis >/=50% per patient, was 36%. On a patient-based analysis, sensitivity, specificity and positive and negative predictive values were 100%, 91%, 83% and 100%, respectively. CONCLUSIONS The diagnostic accuracy of 64-row CTCA for ruling out the presence of significant coronary stenoses in patients undergoing valve surgery is excellent and allows CTCA to be used as a gatekeeper for invasive CCA in these patients. MDCT is a necessary preoperative examination that provides useful information for identifying potential operative complications of surgical procedures.
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Meta-analysis of 40- and 64-MDCT angiography for assessing coronary artery stenosis. AJR Am J Roentgenol 2009; 191:1667-75. [PMID: 19020234 DOI: 10.2214/ajr.07.4022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to assess the diagnostic performance of thin-slice (< or = 0.625 mm) MDCT coronary angiography compared with invasive coronary angiography for the detection of significant (> or = 50%) stenosis. MATERIALS AND METHODS Twenty-two articles on 40- and 64-MDCT coronary angiography were included. Sensitivity and specificity were calculated on a per-patient and per-segment basis; in addition, proximal versus distal segments were evaluated. The effect of nonevaluable patients, nonevaluable segments, and disease prevalence on diagnostic performance was assessed. RESULTS Pooled sensitivity on a patient level was 97.7% ([95% CI] 96.2-98.7%) and specificity 91.0% (88.5-93.1%). Pooled sensitivity on a segmental level was 90.8% (89.0-92.4%) and specificity 95.7% (95.2-96.1%); for proximal segments, respectively, 94.2% (92.3-95.7%) and 94.1% (93.4-94.8%), and for distal segments 84.8% (81.1-88.0%) and 96.9% (96.4-97.4%). If nonevaluable MDCT investigations were included, the per-patient specificity was reduced from 91.0% to 89.1% (p > 0.05) when allocating excluded patients as having significant coronary artery stenosis, and the sensitivity was reduced from 97.7% to 96.2% (p > 0.05) when allocating excluded patients as not having significant stenosis. The per-patient prevalence of coronary artery stenosis had no significant influence on the sensitivity for detecting significant stenosis. CONCLUSION Forty- and 64-MDCT provide good-to-excellent performance in detecting or ruling out significant coronary artery stenosis, with better results for proximal than for distal coronary artery segments.
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le Polain de Waroux JB, Pouleur AC, Goffinet C, Pasquet A, Vanoverschelde JL, Gerber BL. Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging. Eur Heart J 2008; 29:2544-51. [PMID: 18762553 PMCID: PMC2567022 DOI: 10.1093/eurheartj/ehn381] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aims To evaluate whether comprehensive evaluation of coronary anatomy and delayed enhancement (DE) by multidetector-computed tomography (MDCT) would allow determination of etiology of left ventricular dysfunction (LVD) as compared with coronary angiography (CA) and DE-magnetic resonance (CMR). Methods and results Seventy-one consecutive patients (50 males, 59 ± 16 years) with LVD (ejection fraction: 26 ± 11%) of unknown etiology underwent MDCT, LGE (late Gd-DTPA-enhanced)-CMR and CA. Patients were classified into four groups according to coronary artery disease (CAD) by CA and LGE-CMR patterns. Patients (n = 24) with CAD and transmural or sub-endocardial DE by CMR were considered having definite ischaemic LVD (group 1). Patients (n = 36) without CAD by CA and with no/atypical LGE-CMR were considered non-ischaemic LVD (group 2). Further we identified four patients with transmural DE but no CAD (group 3) and seven patients with CAD but no DE (group 4). On per-patient basis, combined coronary and DE-MDCT had excellent agreement (κ = 0.89; P < 0.001) with CA/LGE-CMR to classify patients into the same four groups. Sensitivity, specificity and accuracy of MDCT were 97, 92 and 94%, respectively for detecting patients with definite (group 1) or likely (groups 3 and 4) ischaemic LVD. Conclusion Combined coronary and DE-MDCT can accurately differentiate ischaemic vs. non-ischaemic etiology of LVD.
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Pouleur AC, le Polain de Waroux JB, Kefer J, Pasquet A, Vanoverschelde JL, Gerber BL. Direct comparison of whole-heart navigator-gated magnetic resonance coronary angiography and 40- and 64-slice multidetector row computed tomography to detect the coronary artery stenosis in patients scheduled for conventional coronary angiography. Circ Cardiovasc Imaging 2008; 1:114-21. [PMID: 19808528 DOI: 10.1161/circimaging.107.756304] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both whole-heart magnetic resonance coronary angiography (WH-MRCA) and multidetector computed tomography (MDCT) have been proposed for the noninvasive identification of the coronary stenosis. The authors sought to directly compare the diagnostic accuracy of these noninvasive imaging techniques using the invasive quantitative coronary angiography as a reference standard. METHODS AND RESULTS Seventy-seven consecutive patients (56 men, 61+/-14 years) prospectively underwent WH-MRCA and 40- or 64-slice MDCT before the quantitative coronary angiography. Diagnostic accuracy of WH-MRCA and MDCT for the visual identification of >50% diameter stenosis in segments of >1.5 mm size was compared using the quantitative coronary angiography as a reference. According to the quantitative coronary angiography, 49 of 992 coronary segments >1.5 mm diameter had >50% diameter stenosis. MDCT had a higher success rate (100% versus 88%, P<0.001) and enabled identification of more segments (963 versus 726, P<0.001) than did WH-MRCA. On a per-segment basis, WH-MRCA had similar sensitivity (47/49 or 96% versus 48/49 or 98%, P=0.9) but significantly lower specificity (644/943 or 68% versus 863/943 or 92%, P<0.001) and accuracy (691/992 or 70% versus 911/992 or 92%, P<0.001) for the detection of >50% diameter stenosis than did MDCT. On a per-patient basis, the sensitivity was similar (17/17 or 100% versus 16/17 or 94%, P=0.9), but specificity (43/60 or 72% versus 53/60 or 88%, P=0.024) and diagnostic accuracy (60/77 or 78%, versus 69/77 or 90%, P=0.044) of WH-MRCA for the detection of >50% diameter stenosis were significantly lower than of MDCT. CONCLUSIONS Because of the higher success rate and higher number of interpretable segments, 40- or 64-slice MDCT performs better than WH-MRCA.
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Cademartiri F, La Grutta L, Malagò R, Alberghina F, Meijboom WB, Pugliese F, Maffei E, Palumbo AA, Aldrovandi A, Fusaro M, Brambilla V, Coruzzi P, Midiri M, Mollet NRA, Krestin GP. Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography. Eur Radiol 2008; 18:781-91. [PMID: 18246357 PMCID: PMC2270369 DOI: 10.1007/s00330-007-0821-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 09/26/2007] [Accepted: 11/06/2007] [Indexed: 11/30/2022]
Abstract
The aim of our study was to assess the prevalence of variants and anomalies of the coronary artery tree in patients who underwent 64-slice computed tomography coronary angiography (CT-CA) for suspected or known coronary artery disease. A total of 543 patients (389 male, mean age 60.5 ± 10.9) were reviewed for coronary artery variants and anomalies including post-processing tools. The majority of segments were identified according to the American Heart Association scheme. The coronary dominance pattern results were: right, 86.6%; left, 9.2%; balanced, 4.2%. The left main coronary artery had a mean length of 112 ± 55 mm. The intermediate branch was present in the 21.9%. A variable number of diagonals (one, 25%; two, 49.7%; more than two, 24%; none, 1.3%) and marginals (one, 35.2%; two, 46.2%; more than two, 18%; none, 0.6%) was visualized. Furthermore, CT-CA may visualize smaller branches such as the conus branch artery (98%), the sinus node artery (91.6%), and the septal branches (93%). Single or associated coronary anomalies occurred in 18.4% of the patients, with the following distribution: 43 anomalies of origin and course, 68 intrinsic anomalies (59 myocardial bridging, nine aneurisms), three fistulas. In conclusion, 64-slice CT-CA provides optimal visualization of the variable and complex anatomy of coronary arteries because of the improved isotropic spatial resolution and flexible post-processing tool.
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Affiliation(s)
- Filippo Cademartiri
- Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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