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CLINICAL RESEARCH: CARDIAC IMAGING

Pre-Operative Computed Tomography Coronary Angiography to Detect Significant Coronary Artery Disease in Patients Referred for Cardiac Valve Surgery

Willem B. Meijboom, MD^_*,, Nico R. Mollet, MD, PhD^_*,, Carlos A.G. Van Mieghem, MD^_*,, Jolanda Kluin, MD, PhD, Annick C. Weustink, MD^_*,, Francesca Pugliese, MD^_*,, Eleni Vourvouri, MD, PhD^_*,, Filippo Cademartiri, MD, PhD^_*,, Ad J.J.C. Bogers, MD, PhD, Gabriel P. Krestin, MD, PhD and Pim J. de Feyter, MD, PhD, FACC^_*,,_*

^_* Cardiology
Radiology
Cardiothoracic Surgery, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands

Manuscript received March 21, 2006; revised manuscript received June 6, 2006, accepted June 19, 2006.

^_* Reprint requests and correspondence: Dr. Pim J. de Feyter, Erasmus Medical Center Department of Cardiology and Radiology, Thoraxcenter, Room Ba 589, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. (Email: p.j.defeyter{at}erasmusmc.nl).

OBJECTIVES: We studied the diagnostic performance of 64-slice computed tomography coronary angiography (CTCA) to rule out or detect significant coronary stenosis in patients referred for valve surgery.

BACKGROUND: Invasive conventional coronary angiography (CCA) is recommended in most patients scheduled for valve surgery.

METHODS: During a 6-month period, 145 patients were prospectively identified from a consecutive patient population scheduled for valve surgery. Thirty-five patients were excluded because of CTCA criteria: irregular heart rhythm (n = 26), impaired renal function (n = 5), and known contrast allergy (n = 4). General exclusion criteria were: hospitalization in community hospital (n = 4), no need for CCA (n = 4), previous coronary artery bypass surgery (n = 1), or percutaneous coronary intervention (n = 4). Of the remaining 97 patients, 27 denied written informed consent. Thus, the study population comprised 70 patients (49 male, 21 female; mean age 63 ± 11 years).

RESULTS: Prevalence of significant coronary artery disease, defined as having at least 1 50% stenosis per patient, was 25.7%. Beta-blockers were administered in 71%, and 64% received lorazepam. The mean heart rate dropped from 72.5 ± 12.4 to 59.5 ± 7.5 beats/min. The mean scan time was 12.8 ± 1.3 s. On a per-patient analysis, the sensitivity, specificity, and positive and negative predictive values were: 100% (18 of 18; 95% confidence interval [CI] 78 to 100), 92% (48 of 52; 95% CI 81 to 98), 82% (18 of 22; 95% CI 59 to 94), and 100% (48 of 48; 95% CI 91 to 100), respectively.

CONCLUSIONS: The diagnostic accuracy of 64-slice CTCA for ruling out the presence of significant coronary stenoses in patients undergoing valve surgery is excellent and allows CTCA implementation as a gatekeeper for invasive CCA in these patients.

Abbreviations and Acronyms   AHA = American Heart Association   CAD = coronary artery disease   CCA = conventional coronary angiogram   CT = computed tomography   CTCA = computed tomography coronary angiogram   ECG = electrocardiographic   LAD = left anterior descending coronary artery   LVF = left ventricular function   QCA = quantitative coronary angiography   RCA = right coronary artery

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