Author + information
- Received September 8, 2015
- Accepted September 24, 2015
- Published online September 1, 2016.
- Maksymilian P. Opolski, MDa,∗ (, )
- Adam D. Staruch, MDa,
- Michal Jakubczyk, PhDb,
- James K. Min, MDc,
- Heidi Gransar, MSd,
- Michal Staruch, MSe,
- Adam Witkowski, MDa,
- Cezary Kepka, MDf,
- Won-Keun Kim, MDg,
- Christian W. Hamm, MDg,h,
- Helge Möllmann, MDg and
- Stephan Achenbach, MDi
- aDepartment of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
- bInstitute of Econometrics, Warsaw School of Economics, Warsaw, Poland
- cDepartment of Radiology, The New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York
- dDepartment of Imaging and Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- eMedical University of Warsaw, Warsaw, Poland
- fDepartment of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
- gDepartment of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
- hDepartment of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany
- iDepartment of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany
- ↵∗Reprint requests and correspondence:
Dr. Maksymilian P. Opolski, Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland.
Objectives This study aimed to evaluate the diagnostic accuracy of coronary computed tomography angiography (CTA) for detecting coronary artery stenoses in patients with valvular heart disease undergoing valve surgery.
Background Coronary CTA is currently not routinely recommended for detecting coronary artery stenoses before cardiac valve surgery. However, recent improvements in computed tomography technology may enable the identification of the most appropriate candidates for coronary CTA before valve surgery.
Methods A systematic review was performed of PubMed, EMBASE, and the Cochrane databases for all studies that used ≥16-detector row computed tomography scanning to perform coronary CTA in patients with valvular heart disease scheduled for valve surgery and validated the results against invasive angiography. Summary diagnostic accuracies were calculated by using a bivariate random effects model, and a generalized linear mixed model was applied for heterogeneity analysis.
Results Seventeen studies analyzing 1,107 patients and 12,851 coronary segments were included. Patient-based analysis revealed a pooled sensitivity of 93% (95% confidence interval [CI]: 86 to 97), specificity of 89% (95% CI: 86 to 91), a negative likelihood ratio (LR) of 0.07 (95% CI: 0.04 to 0.16), and a positive LR of 8.44 (95% CI: 6.49 to 10.99) for coronary CTA to identify individuals with stenosis ≥50%. Specificity and positive LR were higher in patients without aortic stenosis (AS) versus those with AS (96% vs. 87% and 21.2 vs. 7.4, respectively), as well as with ≥64 detectors versus <64 detectors (90% vs. 86% and 9.5 vs. 6.9). Heterogeneity analysis revealed a significant impact of AS and the number of detectors on specificity of CTA.
Conclusions Coronary CTA using currently available technology is a reliable imaging alternative to invasive angiography with excellent sensitivity and negative LR for the detection of significant coronary stenoses in patients undergoing cardiac valve surgery. The specificity of coronary CTA may be decreased against the background of AS (Computed Tomography Angiography for the Detection of Coronary Artery Disease in Patients Referred for Cardiac Valve Surgery: A Meta-Analysis; CRD42015016213)
Dr. Opolski has received a scholarship from the Foundation for Polish Science. Dr. Min has served on the medical advisory boards of GE Healthcare, Arineta, AstraZeneca, and Bristol-Myers Squibb; serves on the Speakers Bureau of GE Healthcare; received research support from GE Healthcare, Vital Images, and Phillips Healthcare; and received grants from the National Institutes of Health/National Heart, Lung and Blood Institute (R01HL111141, R01HL115150, R01HL118019, and U01HL105907) and from the Qatar National Research Foundation (NPRP09-370-3-089). Dr. Kim has served as a proctor for Symetis SA and St. Jude Medical. Dr. Achenbach has received grant support and serves on the Speakers Bureau of Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. João Lima, MD, served as Guest Editor for this paper.
- Received September 8, 2015.
- Accepted September 24, 2015.
- 2016 American College of Cardiology Foundation