Journal article
Diagnostic Accuracy of Coronary Computed Tomography Before Aortic Valve Replacement: Systematic Review and Meta-Analysis
Journal of thoracic imaging, Vol.33(4), pp.207-216
07/2018
DOI: 10.1097/RTI.0000000000000322
PMID: 29389809
Abstract
In aortic stenosis patients referred for surgical and transcatheter aortic valve replacement (AVR), the evidence of diagnostic accuracy of coronary computed tomography angiography (CCTA) has been limited. The objective of this study was to investigate the diagnostic accuracy of CCTA for significant coronary artery disease (CAD) in patients referred for AVR using invasive coronary angiography (ICA) as the gold standard.
We searched databases for all diagnostic studies of CCTA in patients referred for AVR, which reported diagnostic testing characteristics on patient-based analysis required to pool summary sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio. Significant CAD in both CCTA and ICA was defined by >50% stenosis in any coronary artery, coronary stent, or bypass graft.
Thirteen studies evaluated 1498 patients (mean age, 74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of significant stenosis determined by ICA was 43%. Hierarchical summary receiver-operating characteristic analysis demonstrated a summary area under curve of 0.96. The pooled sensitivity, specificity, and positive-likelihood and negative-likelihood ratios of CCTA in identifying significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06, respectively. In subgroup analysis, the diagnostic profiles of CCTA were comparable between surgical and transcatheter AVR.
Despite the higher prevalence of significant CAD in patients with aortic stenosis than with other valvular heart diseases, our meta-analysis has shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for ICA. Our study illustrates a need for further study of the potential role of CCTA in preoperative planning for AVR.
Details
- Title: Subtitle
- Diagnostic Accuracy of Coronary Computed Tomography Before Aortic Valve Replacement: Systematic Review and Meta-Analysis
- Creators
- Kongkiat Chaikriangkrai - University of IowaHye Yeon Jhun - University of Kansas Medical CenterGhanshyam Palamaner Subash Shantha - University of IowaAref Bin Abdulhak - Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IARudhir Tandon - University of Iowa Hospitals and ClinicsMusab Alqasrawi - University of IowaAnthony Klappa - University of Iowa Hospitals and ClinicsSamir Pancholy - The Wright Center for Graduate Medical EducationAbhishek Deshmukh - Mayo Clinic Rochester, MNJay Bhama - University of Iowa Hospitals and ClinicsGardar Sigurdsson - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of thoracic imaging, Vol.33(4), pp.207-216
- DOI
- 10.1097/RTI.0000000000000322
- PMID
- 29389809
- ISSN
- 0883-5993
- eISSN
- 1536-0237
- Language
- English
- Date published
- 07/2018
- Academic Unit
- Gastroenterology and Hepatology; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984359762902771
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