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Zhang Y, Liu Z, Cheng Y, Li Z, Wang Z, Peng L, Li J, Shuai T. New Whole-Heart motion correction algorithm enables diagnostic CT of aortic valve and coronary arteries in systolic phase for transcatheter aortic valve implantation candidates. Eur J Radiol 2023; 168:111141. [PMID: 37832197 DOI: 10.1016/j.ejrad.2023.111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES To investigate the ability of new generation snapshot freeze (NGSSF) algorithm in improving diagnostic image quality of both aortic valve and coronary arteries for transcatheter aortic valve implantation (TAVI) candidates in TAVI planning CT. METHODS Sixty-four TAVI candidates underwent TAVI planning CT were enrolled. Scans from coronary CT angiography were reconstructed at 20%, 30%, 40%, and 75% R-R cardiac phases with NGSSF and standard (STD) algorithm. In each phase, following parameters were compared: aortic valve measurements and their reproducibility; image quality of aortic valve and coronary arteries. The diagnostic accuracies of TAVI planning CT for coronary artery stenosis in 30% R-R phase with NGSSF and STD algorithms were calculated in 47out of 64 patients with invasive coronary angiography as reference standard. RESULTS For subjective image quality evaluation, the excellent rate for aortic valve improved from 25.0% to 93.8% and the interpretable rate for coronary arteries increased from 20.3% to 95.3% in the 30% phase images with NGSSF compared with images with STD. For the detection of > 50% coronary artery stenosis, the 30% phase images with NGSSF provided a sensitivity of 90%, specificity of 81.48%, negative predictive value of 91.7%, and positive predictive value of 78.3% on a per-patient basis; While images with STD, had a corresponding results of 95.0%, 33.33%, 90.0%, and 51.4%, respectively. CONCLUSIONS NGSSF significantly improves image quality for both aortic valve and coronary arteries compared with STD for TAVI patients of all heart rates. NGSSF enables the accurate measurement for aortic valve and satisfactory diagnostic performance for coronary arteries stenosis in the same systolic phase for TAVI planning.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Zixuan Liu
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Yong Cheng
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Ziwei Wang
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, China
| | | | - Tao Shuai
- Department of Radiology, West China Hospital, Sichuan University, China.
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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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Hasselbalch RB, Pries-Heje MM, Kjølhede Holle SL, Engstrøm T, Heitmann M, Pedersen F, Schou M, Mickley H, Elming H, Steffensen R, Koeber L, Iversen K. Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score. Open Heart 2020; 7:openhrt-2020-001380. [PMID: 33020259 PMCID: PMC7537465 DOI: 10.1136/openhrt-2020-001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG). METHODS This was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician's discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk. RESULTS In total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18-48) showed no ischaemic events for patients receiving only MSCT. CONCLUSION The CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Cardiology, Herlev Hospital, Herlev, Denmark .,Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
| | | | | | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev Hospital, Herlev, Denmark.,Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Hanne Elming
- Department of Cardiology, Roskilde Hospital, Roskilde, Sjaelland, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Lars Koeber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, Herlev, Denmark.,Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
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Hwang JW, Park SJ, Kim EK, Chang SA, Choi JO, Lee SC, Ahn JH, Carriere K, Park SW. Clinical implications of exercise-induced regional wall motion abnormalities in significant aortic regurgitation. Echocardiography 2020; 37:1583-1593. [PMID: 33007130 DOI: 10.1111/echo.14855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Significant aortic regurgitation (AR) is sometimes accompanied by regional wall motion abnormalities (RWMA) during exercise stress echocardiography. The aim of this study was to estimate the association between RWMA after exercise and in the presence of significant AR in patients with coronary artery disease (CAD) or volume overload and to predict the eventual need for aortic valve replacement (AVR). METHODS AND RESULTS We retrospectively reviewed 182 patients with significant AR who underwent exercise echocardiography. In addition, we investigated patients with AR who underwent coronary angiography (CAG) or coronary computed tomography angiography (CCTA) and were diagnosed with CAD. The presence of RWMA after exercise was defined as newly developed RWMA after exercise and included all changes in wall motion. Patients were divided into two groups according to the presence of RWMA after exercise: the RWMA group (n = 42) and non-RWMA group (n = 140). In the RWMA group, 31 patients (73.8%) underwent coronary artery evaluation by CAG or CCTA. Only two patients in the RWMA group were diagnosed with current CAD and underwent percutaneous coronary intervention. Patients with RWMA were older (61.6 ± 10.8 vs 52.0 ± 13.7 years, P < .001), had more severe AR (54.8% vs 32.9%), and underwent AVR more frequently (40.5% vs 14.3%, P = .001) than patients without RWMA. METs (odds ratio [OR], 0.796; P = .019), difference between rest and postexercise left ventricular end-diastolic volume (OR, 0.967; P = .001), and the difference between pre- and postexercise left ventricular end-systolic volume (OR, 1.113; P < .001) were identified as independent factors associated with RWMA after exercise according to multivariable logistic regression analysis. The majority of wall motion changes were seen in the lateral and inferior segments, and the locations of wall motion changes were relatively consistent with the direction of the AR jet. The relationship between RWMA after exercise and time to AVR was investigated by simple linear regression (hazard ratio [HR], 3.402; P < .001). After adjusting for baseline parameters of diastolic blood pressure, left ventricular end-systolic dimension (LVESD), aorta size, deceleration time, and METs, the presence of RWMA after exercise was not predictive of time to AVR (HR, 1.106; P = .81). On the other hand, without forcible entry of RWMA after exercise, LVESD (HR, 1.119; P < .001) and METs (HR, 0.828; P = .006) independently predicted the eventual need for AVR as an outcome. CONCLUSION The degree of change in wall motion from rest to exercise in those with significant AR was not correlated with CAD, but was correlated with the severity of volume overload and exercise-induced preload changes, as well as the direction of the AR jet. In addition, RWMA after exercise had no role in predicting the need for AVR.
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Affiliation(s)
- Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics team, Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Keumhee Carriere
- Biostatistics team, Statistics and Data Center, Samsung Medical Center, Seoul, Korea.,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hasselbalch RB, Pries-Heje M, Engstrøm T, Sandø A, Heitmann M, Pedersen F, Schou M, Mickley H, Elming H, Steffensen R, Koeber L, Iversen KK. Coronary risk stratification of patients with newly diagnosed heart failure. Open Heart 2019; 6:e001074. [PMID: 31673386 PMCID: PMC6802977 DOI: 10.1136/openhrt-2019-001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/18/2019] [Accepted: 09/12/2019] [Indexed: 01/07/2023] Open
Abstract
Objective Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD. Methods Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database. Results The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation. Conclusions A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.
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Affiliation(s)
| | - Mia Pries-Heje
- Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Sandø
- Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Hanne Elming
- Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Lars Koeber
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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6
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Chaikriangkrai K, Jhun HY, Shantha GPS, Abdulhak AB, Tandon R, Alqasrawi M, Klappa A, Pancholy S, Deshmukh A, Bhama J, Sigurdsson G. Diagnostic Accuracy of Coronary Computed Tomography Before Aortic Valve Replacement: Systematic Review and Meta-Analysis. J Thorac Imaging 2018; 33:207-216. [PMID: 29389809 DOI: 10.1097/rti.0000000000000322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE In aortic stenosis patients referred for surgical and transcatheter aortic valve replacement (AVR), the evidence of diagnostic accuracy of coronary computed tomography angiography (CCTA) has been limited. The objective of this study was to investigate the diagnostic accuracy of CCTA for significant coronary artery disease (CAD) in patients referred for AVR using invasive coronary angiography (ICA) as the gold standard. MATERIALS AND METHODS We searched databases for all diagnostic studies of CCTA in patients referred for AVR, which reported diagnostic testing characteristics on patient-based analysis required to pool summary sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio. Significant CAD in both CCTA and ICA was defined by >50% stenosis in any coronary artery, coronary stent, or bypass graft. RESULTS Thirteen studies evaluated 1498 patients (mean age, 74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of significant stenosis determined by ICA was 43%. Hierarchical summary receiver-operating characteristic analysis demonstrated a summary area under curve of 0.96. The pooled sensitivity, specificity, and positive-likelihood and negative-likelihood ratios of CCTA in identifying significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06, respectively. In subgroup analysis, the diagnostic profiles of CCTA were comparable between surgical and transcatheter AVR. CONCLUSIONS Despite the higher prevalence of significant CAD in patients with aortic stenosis than with other valvular heart diseases, our meta-analysis has shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for ICA. Our study illustrates a need for further study of the potential role of CCTA in preoperative planning for AVR.
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Affiliation(s)
| | - Hye Yeon Jhun
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS
| | | | - Aref Bin Abdulhak
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Rudhir Tandon
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Musab Alqasrawi
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anthony Klappa
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Samir Pancholy
- The Wright Center for Graduate Medical Education, Scranton, PA
| | | | - Jay Bhama
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Gardar Sigurdsson
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
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7
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Fuchs A, Kühl JT, Chen MY, Viladés Medel D, Alomar X, Shanbhag SM, Helqvist S, Kofoed KF. Subtraction CT angiography improves evaluation of significant coronary artery disease in patients with severe calcifications or stents-the C-Sub 320 multicenter trial. Eur Radiol 2018; 28:4077-4085. [PMID: 29696430 DOI: 10.1007/s00330-018-5418-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/11/2018] [Accepted: 03/08/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Diagnostic accuracy of conventional coronary CT angiography (CCTAconv) may be compromised by blooming artifacts from calcifications or stents. Blooming artifacts may be reduced by subtraction coronary CT angiography (CCTAsub) in which non-contrast and contrast CT data sets are subtracted digitally. We tested whether CCTAsub in patients with severe coronary calcification or stents reduces the number of false-positive stenosis evaluations compared with CCTAconv. METHODS In this study, 180 symptomatic patients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and CT scanned (2013-2016) at three international centers. CCTAconv, and CCTAsub data sets were reconstructed. Target segments were defined as motion-free coronary segments with a suspected stenosis (> 50% of lumen) potentially due to blooming of either calcium or stents. Target segments were evaluated with respect to misregistration artifacts from the CCTAsub reconstruction process, in which case evaluation was omitted. CCTAsub and CCTAconv were compared with ICA. Primary outcome measure was the frequency of false positives by CCTAconv versus CCTAsub to identify > 50% coronary stenosis by ICA on a per-segment level. RESULTS After exclusion of 76 patients, 104 (14% females) with mean age 67 years and median Agatston score 852 were included. There were 136 target segments with misregistration and 121 target segments without. Accuracy calculations in target segments without misregistration showed a reduction of the false positives from 72% [95% confidence interval (CI): 63-80%] in CCTAconv to 33% (CI:25-42%) in CCTAsub, at the expense of 7% (CI:3-14%) false negatives in CCTAsub. CONCLUSIONS In severely calcified coronary arteries or stents, CCTAsub reduces the false-positive rate in well-aligned, calcified or stent segments suspected of significant stenosis on CCTAconv. Nevertheless, misregistration artifacts are frequent in CCTAsub. KEY POINTS • A high calcium-score reduces the diagnostic accuracy in patients scanned with cardiac CT. • These patients would normally need an invasive angiogram for diagnosis. • In this prospective, multicenter study, subtraction CT, when evaluable, reduces false-positive stenosis evaluations. • Subtraction coronary CT angiography may, when evaluable, reduce excessive downstream testing.
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Affiliation(s)
- Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - J Tobias Kühl
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marcus Y Chen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Xavier Alomar
- Clinica Creu Blanca, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sujata M Shanbhag
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steffen Helqvist
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, The Diagnostic Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Coronary risk stratification of patients undergoing surgery for valvular heart disease. Int J Cardiol 2017; 227:37-42. [DOI: 10.1016/j.ijcard.2016.11.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/05/2016] [Indexed: 11/19/2022]
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9
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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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10
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Hwang JW, Kim SM, Park SJ, Cho EJ, Lee SC, Choe YH, Park SW. A Preoperative Assessment of Significant Coronary Stenosis Based on a Semiquantitative Analysis of Coronary Artery Calcification on Noncontrast Computed Tomography in Aortic Stenosis Patients Undergoing Aortic Valve Replacement. Medicine (Baltimore) 2016; 95:e2906. [PMID: 26945385 PMCID: PMC4782869 DOI: 10.1097/md.0000000000002906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive coronary angiography (ICA) is the recommended assessment for coronary artery disease in patients undergoing elective aortic valve replacement (AVR). Noncontrast computed tomography (CT) is useful for evaluating lung lesions and calcifications at the cannulation site of the ascending aorta. The purpose of this study was to evaluate the role of noncontrast CT in the visual assessment of coronary artery calcification (CAC) in patients undergoing AVR. We retrospectively identified patients with significant aortic stenosis (AS) who were referred for AVR between January 2006 and December 2013. Among these, we included 386 patients (53.6% males, 69.2 ± 8.4 years) who underwent both noncontrast CT and ICA. Significant coronary artery stenosis (CAS) in the ICA was defined as luminal stenosis ≥70%. The 4 main coronary arteries were visually assessed on noncontrast CT and were scored based on the Weston score as follows: 0, no visually detected calcium; 1, a single high-density pixel detected; 3, calcium was dense enough to create a blooming artifact; and 2, calcium in between 1 and 3. Four groups were reclassified by the sum of the Weston scores from each vessel, as follows: noncalcification (0); mild calcification (1-4); moderate calcification (5-8); and severe calcification (9-12). Receiver-operating characteristic (ROC) analysis was generated to identify the cutoff Weston score values for predicting significant CAS. Diagnostic estimates were calculated based on these cutoffs. In the ICA analysis, 62 of the 386 patients (16.1%) had significant CAS. All patients were divided into 4 groups. The noncalcification group had 97 subjects (Weston score 0), the mild degree group had 100 (2.6 ± 1.0), the moderate calcification group had 114 (6.6 ± 1.1), and the severe calcification group had 75 (10.7 ± 1.1). The prevalence of significant CAS in the noncalcification, mild, moderate, and severe groups was 1% (1/97), 5% (5/100), 24% (27/114), and 39% (29/75), respectively. The group with CAS had significantly more CAC than the group without CAS (8.37 ± 2.93 vs 4.01 ± 3.75, P < 0.001). The cutoff value (by Weston score) for predicting significant CAS is ≥5 (sensitivity 90.3%, specificity 59.0%, positive predictive value 29.6%, and negative predictive value 97%). The degree of CAC detected on noncontrast CT can help to predict significant CAS in AS patients who are referred for AVR. For the clinicians, the visual assessment of CAC on noncontrast CT was easy and useful for estimating CAS. Therefore, ICA should be recommended to selective patients based on patients' CAC and Weston scores during the preoperative evaluation for elective AVR.
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Affiliation(s)
- Ji-Won Hwang
- From the Department of Medicine, Division of Cardiology (J-WH, S-JP, S-CL, SWP); Department of Radiology (SMK, YHC); Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (SMK, SJP, S-CL, YHC, SWP); and Division of Cardiology, Department of Medicine, National Cancer Center, Goyang, Korea (EJC)
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Larsen LH, Kofoed KF, Carstensen HG, Dalsgaard M, Ersbøll MK, Køber L, Hassager C. Prognostic value of multi-detector computed tomography in asymptomatic aortic valve stenosis. Int J Cardiol 2016; 203:331-7. [DOI: 10.1016/j.ijcard.2015.10.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 09/28/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
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12
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Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study. Atherosclerosis 2015; 243:631-7. [DOI: 10.1016/j.atherosclerosis.2015.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/20/2015] [Accepted: 10/07/2015] [Indexed: 01/07/2023]
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Opolski MP, Kim WK, Liebetrau C, Walther C, Blumenstein J, Gaede L, Kempfert J, Van Linden A, Walther T, Hamm CW, Möllmann H. Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation. Clin Res Cardiol 2015; 104:471-80. [PMID: 25559245 DOI: 10.1007/s00392-014-0806-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/23/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to investigate the diagnostic accuracy of a standardized computed tomography angiography (CTA) for the identification of significant coronary artery disease (CAD) in patients evaluated for transcatheter aortic valve implantation (TAVI). BACKGROUND The diagnostic performance of CTA for the detection of CAD in patients with aortic stenosis referred for TAVI has thus far not been validated. METHODS A consecutive series of 475 patients (194 male, mean age: 82 ± 6 years) with CTA data sets obtained during the routine diagnostic work-up before TAVI were included. A total of 6,603 coronary segments in 1,899 coronary arteries ≥ 1.5 mm in diameter and 271 grafts were evaluated for the presence of significant CAD defined as ≥ 50% luminal narrowing. Results were compared with invasive coronary angiography as the standard of reference. RESULTS Prevalence of significant CAD was 57% (270/475), and 5,925 coronary segments (90%) and 257 bypass grafts (95%) were evaluable by CTA. In the per-patient analysis, sensitivity (Se), specificity, and positive and negative predictive values (NPV) were 98, 37, 67 and 94%, respectively. CTA showed satisfactory ability to exclude significant CAD in the following subgroups: (1) patients (221/475) without prior known CAD (Se: 97%, NPV: 97%), (2) patients (13/475) without prior known CAD and absent coronary calcification (NPV: 100%) and (3) bypass grafts (Se: 97%, NPV: 99%). CONCLUSIONS Comprehensive evaluation of a pre-TAVI CTA could prove to be a useful rule-out test for significant CAD in selected subgroups of patients.
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Affiliation(s)
- Maksymilian P Opolski
- Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
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Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R. Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis. Int J Cardiovasc Imaging 2014; 31:485-95. [DOI: 10.1007/s10554-014-0572-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
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