CT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic valve replacement
CT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic valve replacement
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DOI：
10.1016/j.jcct.2017.06.001
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发表时间：
2017-09-01
影响因子：
5.4
通讯作者：
Pugliese, Francesca
中科院分区：
文献类型：
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作者：
Rossi, Alexia;De Cecco, Carlo N.;Pugliese, Francesca
背景：冠状动脉疾病（CAD）和主动脉狭窄具有相同的病理生理机制和危险因素。我们评估了冠状动脉计算机断层血管造影（CTA）的临床应用，以确定经导管主动脉瓣置换术（TAVR）中严重主动脉瓣狭窄患者的CAD和血运重建需求。方法：连续无冠心病的患者行钙评分、CTA和有创冠状动脉造影（ICA）。使用第二代双源CT扫描仪。以ica -定量冠状动脉造影（QCA）为参考标准。冠心病报告使用宽松的阈值>= 50%和严格的阈值>= 70%直径缩小。>= 70%内径缩小和高危冠心病的结果用于预测血运重建。结果：纳入140例患者[男性68例；82.3（7.7）年]。140例患者中有58例（41%）出现ICA 50%阈值定义的CAD。140例患者中有23例（16%）出现70%阈值的CAD。140例患者中有16例（11%）存在高危CAD。CTA与ICA预测血运重建的奇比相似，分别为3.22（1.26-8.23）和4.62（1.64-13.05）。42 /140（30%）患者钙评分= 400。低钙评分组CTA的诊断效能优于高钙评分组（AUC 0.81 vs 0.63）。结论：CTA在严重冠状动脉钙化的TAVR患者中是否排除CAD作为ICA的看门人仍存在疑问。在冠状动脉钙化程度较轻的患者中（占本研究参与者的30%），CTA可能发挥临床作用。(C) 2017年心血管计算机断层摄影学会。Elsevier Inc.出版。版权所有。
Background: Coronary artery disease (CAD) and aortic stenosis share pathophysiological mechanisms and risk factors. We evaluated the clinical utility of coronary computed tomography angiography (CTA) to identify CAD and revascularization requirement in patients with severe aortic stenosis considered for transcatheter aortic valve replacement (TAVR).Methods: Consecutive patients without known CAD underwent calcium scoring, CTA and invasive coronary angiography (ICA). A second-generation dual-source CT scanner was used. ICA-quantitative coronary angiography (QCA) served as reference standard. CAD was reported using a lenient threshold of >= 50% and a stricter threshold of >= 70% diameter reduction. Findings of >= 70% diameter reduction and of high-risk CAD were used to predict revascularization.Results: The study included 140 patients [68 males; 82.3 (7.7) years]. CAD defined by the 50% threshold on ICA was found in 58/140 (41%) patients. CAD by the 70% threshold was found in 23/140 (16%) patients. High-risk CAD was found in 16/140 (11%) patients. CTA and ICA had similar odd-ratios of 3.22 (1.26-8.23) and 4.62 (1.64-13.05), respectively, in predicting revascularization. Forty-two/140 (30%) patients had = 400 calcium score. The diagnostic performance of CTA in the low calcium score group was better than the high calcium score group (AUC 0.81 vs. 0.63).Conclusion: CTA remained questionable to rule-out CAD as gatekeeper to ICA in TAVR candidates who had severe coronary calcifications. In patients with less severe coronary calcifications, accounting for 30% of participants in this study, CTA may play a clinical role. (C) 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.