Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation
Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation
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DOI：
10.1007/s00392-014-0806-z
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发表时间：
2015-06-01
影响因子：
5
通讯作者：
Moellmann, Helge
中科院分区：
文献类型：
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作者：
Opolski, Maksymilian P.;Kim, Won-Keun;Moellmann, Helge
我们的目的是调查标准化计算机断层扫描血管造影 (CTA) 在评估经导管主动脉瓣植入 (TAVI) 的患者中识别显着冠状动脉疾病 (CAD) 的诊断准确性。迄今为止，CTA 对转诊至接受 TAVI 的主动脉瓣狭窄患者的 CAD 检测的诊断性能尚未得到验证。使用 CTA 数据集对 475 名患者（194 名男性，平均年龄：82 +/- A 6 岁）进行了连续系列研究在纳入 TAVI 之前的常规诊断检查中获得的结果。对 1,899 根直径为千分之 1.5 毫米的冠状动脉和 271 个移植物中总共 6,603 个冠状动脉节段进行了评估，以确定是否存在显着的 CAD（定义为千分之一 50% 的管腔狭窄）。将结果与侵入性冠状动脉造影作为参考标准进行比较。显着 CAD 的患病率为 57% (270/475)，CTA 可评估 5,925 个冠状动脉节段 (90%) 和 257 个旁路移植物 (95%)。在每名患者的分析中，敏感性 (Se)、特异性以及阳性和阴性预测值 (NPV) 分别为 98%、37%、67% 和 94%。 CTA 在排除以下亚组中的显着 CAD 方面表现出令人满意的能力：(1) 既往无 CAD 的患者 (221/475)（Se：97 %，NPV：97 %），(2) 既往无 CAD 且无冠状动脉钙化 (NPV：100 %) 的患者 (13/475) 和 (3) 旁路移植术（Se：97 %，NPV：99 %）。 TAVI 前 CTA 评估可能被证明是对选定的患者亚组中显着 CAD 的有用排除测试。
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).The diagnostic performance of CTA for the detection of CAD in patients with aortic stenosis referred for TAVI has thus far not been validated.A consecutive series of 475 patients (194 male, mean age: 82 +/- A 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 a parts per thousand yen1.5 mm in diameter and 271 grafts were evaluated for the presence of significant CAD defined as a parts per thousand yen50 % luminal narrowing. Results were compared with invasive coronary angiography as the standard of reference.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 %).Comprehensive evaluation of a pre-TAVI CTA could prove to be a useful rule-out test for significant CAD in selected subgroups of patients.