Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement
Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement
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DOI：
10.1016/j.ahj.2014.04.022
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发表时间：
2014-09-01
影响因子：
4.8
通讯作者：
Pepi, Mauro
中科院分区：
文献类型：
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作者：
Andreini, Daniele;Pontone, Gianluca;Pepi, Mauro
背景多层计算机断层扫描(MDCT)可对经导管主动脉瓣置换术(TAVR)患者的瓣环和髂股血管进行详细评估。然而，有关多层螺旋CT冠状动脉造影术(MDCT-CA)诊断性能的数据很少。本研究的目的是评价MDCT在TAVR前对冠状动脉的诊断价值。方法325例患者(234例无心肌血管重建史，49例有冠状动脉支架植入史，42例有冠状动脉旁路移植术史)在TAVR前接受了有创冠状动脉造影和多层螺旋CT扫描。使用与标准多层螺旋CT主动脉环评估相同的数据集进行MDCT-CA。结果以有创冠状动脉造影术为标准，评价多层螺旋CT冠状动脉成像的可评价性和诊断准确性。结果多层螺旋CT冠脉成像的可评性为95.6%。不可评价的主要原因是冠脉钙化导致的射束硬化伪影。在基于节段的分析中，MDCT-CA对检测50%狭窄的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性分别为91%、99.2%、83.4%、99.6%和98.8%。冠状动脉支架的MDCT-CA可评价性为82.1%。在基于节段的分析中，MDCT-CA检测支架内再狭窄的敏感性、特异性、PPV、NPV和准确性分别为94.1%、86.7%、66.7%、98.1%和88.3%。所有冠脉搭桥术均符合MDCT-CA标准。在以患者为基础的分析中，MDCT-CA的敏感性、特异性、PPV、NPV和准确性分别为89.7%、90.8%、80.6%、95.4%和90.5%。结论多层螺旋CT-CA可以正确排除TAVR患者存在明显的冠状动脉狭窄、支架内再狭窄和CABG。
Background Multidetector computed tomography (MDCT) provides detailed assessment of valve annulus and iliofemoral vessels in transcatheter aortic valve replacement (TAVR) patients. However, data on diagnostic performance of MDCT coronary angiography (MDCT-CA) are scarce. The aim of the study is to assess diagnostic performance of MDCT for coronary artery evaluation before TAVR.Methods A total of 325 consecutive patients (234 without previous myocardial revascularization, 49 with previous coronary stenting, and 42 with previous coronary artery bypass graft [CABG]) underwent invasive coronary angiography and MDCT before TAVR. MDCT-CA was performed using the same data set dedicated to standard MDCT aortic annulus evaluation. Multidetector computed tomography-CA evaluability and diagnostic accuracy in comparison with invasive coronary angiography as criterion standard were assessed.Results The MDCT-CA evaluability of native coronaries was 95.6%. The leading cause of unevaluability was beam-hardening artifact due to coronary calcifications. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting >= 50% stenosis of 91%, 99.2%, 83.4%, 99.6% and 98.8%, respectively. The MDCT-CA evaluability of coronary stents was 82.1%. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy for detecting >= 50% in-stent restenosis of 94.1%, 86.7%, 66.7%, 98.1%, and 88.3%, respectively. All CABGs were correctly assessed by MDCT-CA. In a patient-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy of 89.7%, 90.8%, 80.6%, 95.4%, and 90.5%, respectively.Conclusions Multidetector computed tomography-CA allows to correctly rule out the presence of significant native coronary artery stenosis, significant in-stent restenosis, and CABG disease in patients referred for TAVR.