Published Online
on April 6, 2009

A more recent version of this article appeared on July 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/4/306    most recent CIRCIMAGING.108.827717v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bettencourt, N. Articles by Gama, V. Search for Related Content PubMed PubMed Citation Articles by Bettencourt, N. Articles by Gama, V. Related Collections Valvular heart disease Coronary imaging: angiography/ultrasound/Doppler/CC CT and MRI CV surgery: valvular disease Angiography Computerized tomography and Magnetic Resonance Imaging Related Article

Original Article

Multislice computed tomography in the exclusion of coronary artery disease in pre-surgical valve disease patients

Nuno Bettencourt^1,4; João Rocha¹; Mónica Carvalho¹; Daniel Leite¹; Andre Michael Toschke²; Bruno Melica¹; Lino Santos¹; Alberto Rodrigues¹; Manuel Gonçalves¹; Pedro Braga¹; Madalena Teixeira¹; Lino Simões¹; Sanjay Rajagopalan³ and Vasco Gama¹

¹ Centro Hospitalar de Gaia–Espinho, Porto, Portugal;
² King's College London, London, United Kingdom;
³ Ohio State University, Columbus, OH

⁴ E-mail: bettencourt.n{at}gmail.com

Background—Multislice computed tomography (MSCT) has shown high negative predictive value in ruling out obstructive coronary artery disease (CAD). Preliminary studies in patients with valvular heart disease (VHD) have demonstrated the potential of MSCT angiography (CTA) in such patients precluding need for invasive angiography (XA). However, larger prospectively designed studies, including patients with atrial fibrillation (AF) and incorporating dose reduction algorithms, are needed.

Methods and Results—To evaluate the clinical utility of 64-slice-CT in the pre-operative assessment in patients with VHD, we prospectively studied 452 consecutive patients undergoing a routine cardiac catheterization for eligibility. 237 patients underwent both MSCT and XA. Segment-based, vessel-based and patient-based agreement between CTA and XA was estimated assuming that "non-evaluable" segments were positive for a significant coronary stenosis. In a patient-based analysis, sensitivity, specificity, positive predictive value and negative predictive value of CTA were 95%, 89%, 66% and 99%, respectively. In vessel based analysis were 90%, 92%, 48%, and 99% while in segment-based analysis were 89%, 97%, 38% and 100%, respectively. No significant differences were found between patients with or without AF. A CAC value of 390 was found to be the best cut-off for the identification of patients with positive or inconclusive CTA (which would not be exempted from XA in the clinical setting).

Conclusions—In the pre-operative assessment of patients with predominant VHD, the diagnostic accuracy of 64-slice CTA for ruling out the presence of significant CAD is very good even when including patients with irregular heart rhythm. Using this approach, CAC quantification prior to CTA can be successfully used to identify patients who should be referred directly to XA, sparing unnecessary exposure to radiation.

Key Words: angiography • coronary disease • tomography • valves • calcium score

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Circ Cardiovasc Imaging 2009 2: 279-281. [Extract] [Full Text] [PDF]

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				P. T. O'Gara One More Step for Computed Tomography Coronary Angiography Before Heart Valve Surgery Circ Cardiovasc Imaging, July 1, 2009; 2(4): 279 - 281. [Full Text] [PDF]