CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis

Journal article


Publication Details

Author(s): Opolski MP, Staruch AD, Jakubczyk M, Min JK, Gransar H, Staruch M, Witkowski A, Kepka C, Kim WK, Hamm CW, Moellmann H, Achenbach S
Journal: Journal of the American College of Cardiology : Cardiovascular imaging
Publication year: 2016
Volume: 9
Journal issue: 9
Pages range: 1059-1070
ISSN: 1936-878X
eISSN: 1876-7591


Abstract

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).


FAU Authors / FAU Editors

Achenbach, Stephan Prof. Dr. med.
Medizinische Klinik 2 - Kardiologie, Angiologie


External institutions with authors

Cedars-Sinai Medical Center
Institute of Cardiology in Warsaw
Kerckhoff-Klinik
New York Presbyterian Hospital
SGH Warsaw School of Economics
Wrocław Medical University / Uniwersytet Medyczny we Wrocławiu


How to cite

APA:
Opolski, M.P., Staruch, A.D., Jakubczyk, M., Min, J.K., Gransar, H., Staruch, M.,... Achenbach, S. (2016). CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis. Journal of the American College of Cardiology : Cardiovascular imaging, 9(9), 1059-1070. https://dx.doi.org/10.1016/j.jcmg.2015.09.028

MLA:
Opolski, Maksymilian P., et al. "CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis." Journal of the American College of Cardiology : Cardiovascular imaging 9.9 (2016): 1059-1070.

BibTeX: 

Last updated on 2018-09-10 at 13:10