CLINICAL RESEARCH: CARDIAC IMAGING
Accuracy of Multislice Computed Tomography in the Preoperative Assessment of Coronary Disease in Patients With Aortic Valve Stenosis
Martine Gilard, MD*,*,
Jean-Christophe Cornily, MD*,
Pierre-Yves Pennec, MD*,
Cedric Joret*,
Grégoire Le Gal, MD ,
Jacques Mansourati, MD*,
Jean-Jacques Blanc, MD* and
Jacques Boschat, MD*
* Department of Cardiology, Brest University Hospital, Brest, France
EA 3878 and the Department of Internal Medicine, Brest University Hospital, Brest, France.
Manuscript received July 18, 2005;
revised manuscript received November 28, 2005,
accepted November 30, 2005.
* Reprint requests and correspondence: Dr. Martine Gilard, Department of Cardiology, La Cavale Blanche Hospital, 29609 Brest Cedex, France. (Email: martine.gilard{at}chu-brest.fr).
OBJECTIVES: To evaluate multislice computed tomography (MSCT) as an alternative to coronary angiography, we prospectively studied its diagnostic accuracy for the detection of significant coronary artery lesions in patients with significant aortic valve stenosis undergoing valve surgery.
BACKGROUND: In patients with aortic valve stenosis, coronary angiography is still recommended before surgery. Multislice computed tomography is a promising noninvasive technique for the detection of significant coronary artery lesions.
METHODS: Fifty-five consecutive patients scheduled for coronary angiography in the preoperative assessment of aortic valve stenosis underwent 16-slice MSCT 24 h before coronary angiography. We analyzed coronary lesions, image quality, and arterial calcium score.
RESULTS: The sensitivity of the MSCT-based strategy in detecting significant stenosis was 100%, and its specificity 80%. The positive and negative predictive values were respectively 55% and 100%. For calcium scores <1,000 (77% of patients), MSCT detected all patients without coronary artery disease, enabling conventional coronary angiography to be avoided in 35 of 55 cases (80%). For calcium scores >1,000, MSCT enabled conventional coronary angiography to be avoided in only 6% of cases, either because significant stenosis was found with a possible indication of revascularization, or because the examination was not interpretable.
CONCLUSIONS: The results of this initial experience in relatively few patients suggest that MSCT-based coronary angiography may serve as an alternative to invasive coronary angiography to rule out significant coronary artery disease in patients scheduled for elective aortic valve replacement. Larger studies are necessary to fully explore the potential of coronary MSCT to improve preoperative risk stratification.
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Abbreviations and Acronyms
| | ASE = Agatston score equivalent | | CAD = coronary artery disease | | MSCT = multislice spiral computed tomography | | ROC = receiver-operating characteristic |
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