Coronary computed tomography versus coronary angiography for preoperative coronary assessment before valve surgery

Abstract Background Conventional coronary angiography (CAG) is currently the gold standard technique for the assessment of coronary arteries prior to cardiac valve surgery. Although CAG is a relatively safe procedure, however, it is still an invasive procedure, and it has potential hazards and complications. Coronary computed tomography angiography (CCTA) is a non-invasive technique that has emerged robustly as an excellent and attractive tool for delineating coronary anatomy. Therefore, we sought to evaluate the accuracy of CCTA when compared with the gold standard CAG in the evaluation of coronary arteries before valve surgery. We screened 111 consecutive patients with VHD undergoing a routine cardiac catheterization for preoperative evaluation of CAD. Fifty patients were eligible and underwent both CAG and CCTA. Significant coronary stenosis was defined as a luminal diameter decrease of ≥ 50%. Additionally, ectasia, calcifications, and congenital coronary anomalies were analyzed. Also, we compared both techniques regarding radiation dose, contrast volume, and complications. Non-evaluable segments were excluded from all levels of analysis. Sixty-one patients were excluded from the study due to various reasons. Results Among the 50 patients of the study population, 27 (54%) were males. The prevalence of significant CAD in the study population was 19.6% according to the patient-based analysis, and CAG could have been avoided in 80.4% of patients with a true-negative CCTA result. Diagnostic accuracy of CCTA for detection of significant stenosis was evaluated regarding sensitivity and specificity, positive predictive value, negative predictive value, and overall accuracy of CCTA, which was 87.5%, 99.6%,87.5%, 99.6%, and 99.2%, respectively, for segmental-based analysis; 86%, 100%, 100%, 99%, and 99%, respectively, for vessel-based analysis; and 77.8%,100%,100%, 94.9%, and 95.7%, respectively, for patient-based analysis. Fewer rates of complications were encountered with CCTA. Additional information obtained like calcifications and congenital anomalies was diagnosed better with CCTA than CAG. Conclusion Owing mainly to its high negative predictive value, a well-performed CCTA exam is an excellent method to rule out coronary artery disease, specially in patients who are not at high risk of atherosclerosis.

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The Functional Severity Assessment of Coronary Stenosis Using Coronary Computed Tomography Angiography-Based Myocardial Mass at Risk and Minimal Lumen Diameter

Cardiovascular Therapeutics ◽

10.1155/2020/6716130 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Kenji Sadamatsu ◽

Kazuhiro Nagaoka ◽

Yasuaki Koga ◽

Kotaro Kagiyama ◽

Kohei Muramatsu ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Angiography ◽

Computed Tomography Angiography ◽

Predictive Value ◽

Coronary Stenosis ◽

Coronary Computed Tomography Angiography ◽

Quantitative Coronary Angiography ◽

Myocardial Mass ◽

Coronary Computed Tomography ◽

Minimal Lumen Diameter

Background. We investigated whether or not the addition of myocardial mass at risk (MMAR) to quantitative coronary angiography was useful for diagnosing functionally significant coronary stenosis in the daily practice. Methods. We retrospectively enrolled 111 consecutive patients with 149 lesions who underwent clinically indicated coronary computed tomography angiography and subsequent elective coronary angiography with fractional flow reserve (FFR) measurement. MMAR was calculated using a workstation-based software program with ordinary thin slice images acquired for the computed tomography, and the minimal lumen diameter (MLD) and the diameter stenosis were measured with quantitative coronary angiography. Results. The MLD and MMAR were significantly correlated with the FFR, and the MMAR-to-MLD ratio (MMAR/MLD) showed a good correlation. The area under the receiver operating characteristic curve (AUC) of MMAR/MLD for FFR ≤ 0.8 was 0.746, and the sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 83%, 68%, and 77%, respectively, at a cut-off value of 29.5 ml/mm. The addition of MMAR/MLD to diameter stenosis thus made it possible to further discriminate lesions with FFR ≤ 0.8 (AUC = 0.750). For the proximal left coronary artery lesions, in particular, MMAR/MLD showed a better correlation with the FFR, and the AUC of MMAR/MLD for FFR ≤ 0.8 was 0.919 at a cut-off value of 31.7 ml/mm. Conclusions. The index of MMAR/MLD correlated well with the physiological severity of coronary stenosis and showed good accuracy for detecting functional significance. The MMAR/MLD might be a useful parameter to consider when deciding the indication for revascularization.

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Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x13165261993996 ◽

2011 ◽

Vol 93 (8) ◽

pp. 639-641 ◽

Cited By ~ 4

Author(s):

VCY Tang ◽

A Attwell-Heap

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Ureteral Stent ◽

The Difference ◽

Contrast Ct ◽

Sensitivity Specificity

INTRODUCTION The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS Our study suggests that non-contrast CT is inferior to the ‘gold standard’ of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.

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Efficacy of Coronary Computed Tomography Angiography for the De Novo Detection of Chronic Total Occlusion Prior to Coronary Angiography: A Preliminary and Retrospective Study

International Journal of Angiology ◽

10.1055/s-0040-1716328 ◽

2020 ◽

Vol 29 (04) ◽

pp. 223-228

Author(s):

Dae Hyun Lee ◽

S. Kambhampati ◽

M. Mohammed ◽

R. Goli ◽

D. Thiemann ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Angiography ◽

Computed Tomography Angiography ◽

Predictive Value ◽

Chronic Total Occlusion ◽

De Novo ◽

Coronary Computed Tomography Angiography ◽

Coronary Intervention ◽

Total Occlusion ◽

Coronary Computed Tomography

AbstractCoronary computed tomography angiography (CCTA) offers high-resolution anatomic characterization of the coronary vasculature but may be suboptimal for lesions dependent on real-time visualization of flow including chronic total occlusion (CTO). In CTOs, heavy calcification and distal vessel opacification from collateralization may confound luminal assessment. Several studies have examined the role of CCTA in characterizing known CTOs to guide percutaneous coronary intervention (PCI). However, the efficacy of CCTA in the de novo diagnosis of CTOs prior to coronary angiography (CAG) has not been demonstrated. A total of 233 consecutive patients who presented for CAG within a 3-month period of having CCTA were retrospectively reviewed. Those patients with prior diagnosis of CTO or prior bypass of the occluded vessels were excluded. Sensitivity and specificity analysis of CCTA in identifying CTOs using CAG as the gold standard was performed. The prevalence of CTO was 21.11% in the population that met criteria for analysis (n = 199). The sensitivity of CCTA in predicting CTO was 57.1%, while the specificity was 96.8%. The positive predictive value and negative predictive value of CCTA in detection of CTO were 82.8 and 89.4%, respectively. Our study shows that CCTA has excellent specificity but poor sensitivity in the detection of CTO thus limiting its clinical use in de novo diagnosis. Further studies to determine the effect of de novo CTO diagnosis on clinically important procedural factors, such as radiation exposure, contrast use, and need for repeat procedures, are warranted and may implicate a role for CCTA in this setting.

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Computed tomography coronary angiography: Is radiation a concern for the gold standard test for anomalous coronary arteries?

JRSM Cardiovascular Disease ◽

10.1177/2048004013513745 ◽

2014 ◽

Vol 3 ◽

pp. 204800401351374

Author(s):

Khaled Alfakih ◽

Sanjay Sharma

Keyword(s):

Computed Tomography ◽

Coronary Angiography ◽

Coronary Arteries ◽

Gold Standard ◽

Standard Test ◽

Computed Tomography Coronary Angiography ◽

Gold Standard Test ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

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Diagnostic Accuracy of BISAP Score for Detecting Acute Pancreatitis Keeping Computed Tomography Severity Index as GS

10.53350/pjmhs2115113164 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3164-3165

Author(s):

Mohammad Iltaf ◽

Sana Akhtar ◽

Dilaram Khan

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Severe Acute Pancreatitis ◽

Predictive Value ◽

Gold Standard ◽

Severity Index ◽

Cross Sectional

Objective: To establish the diagnostic accuracy of BISAP in detecting the severe acute pancreatitis keeping computed tomography severity index as gold standard. Study Design: Cross-sectional study Place and Duration of Study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar from April 16th 2018 to 16th October 2018. Methodology: One hundred and twenty nine patients of age range of 18-60, of either gender having severe acute pancreatitis were included. While patients already diagnosed as severe acute pancreatitis and having known history of chronic pancreatitis were excluded. Patients were subjected to CT scan to confirm whether the severe acute pancreatitis is present or not. All CT scans were reported by single experiences radiologist. Results: There were 30.3% were males and 69.7% were females with mean age 42±11.03 years. BISAP had sensitivity 92.74%, specificity 80%, positive predictive value 99.13%, negative predictive value 20.76% and the overall diagnostic accuracy was 92.24%. Conclusion: BISAP had sensitivity 93.61%, specificity 100%, positive predictive value 100%, negative predictive value 40% and the overall diagnostic accuracy was 93.87% in severe acute pancreatitis keeping CT severity index as gold standard. Keywords: Accuracy, Severe acute pancreatitis, Computed tomography

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Detection of Coronary Artery Diseases: Comparative Study of Multidetector Computed Tomography Angiogram (64 slice scanner) and Conventional Angiogram

Cardiovascular Journal ◽

10.3329/cardio.v4i2.10455 ◽

2012 ◽

Vol 4 (2) ◽

pp. 120-126

Author(s):

M Shirin ◽

SA Azad ◽

M Rahman ◽

S Dina ◽

E Karim ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Positive Predictive Value ◽

Comparative Study ◽

Negative Predictive Value ◽

Predictive Value ◽

Vessel Disease ◽

Triple Vessel Disease ◽

Sensitivity Specificity

Background: Multislice computed tomography (MDCT) is a promising noninvasive method of detecting coronary artery disease. It is not yet being widely used in Bangladesh. We aimed to assess the diagnostic accuracy of the of 64 slice CT in detecting CAD with reference to conventional coronary angiography. Methods: It was cross sectional comparative study conducted in National Institute of Cardiovascular Diseases and Bangabandhu Sheikh Mujib Medical University. Total 80 patients were included in the study who underwent MDCT and coronary angiogram. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for single vessel disease were 87.5%, 96.4%, 91.3%, 94.7% and 93.75% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for double vessel disease were 84.0%, 94.5%, 87.5%, 92.85% and 91.25% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for triple vessel disease were 69.5%, 91.22%, 76.19%, 88.13% and 85.0% respectively. Conclusion: Coronary angiography is a promising technology that already appears to have high performance to assess patient base, vessel base and segment base sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detecting coronary artery stenosis. DOI: http://dx.doi.org/10.3329/cardio.v4i2.10455 Cardiovasc. j. 2012; 4(2): 120-126

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Predictive Value of Noninvasive Coronary Angiography With Multidetector Computed Tomography to Detect Significant Coronary Stenosis Before Valve Surgery

The American Journal of Cardiology ◽

10.1016/j.amjcard.2005.12.039 ◽

2006 ◽

Vol 97 (10) ◽

pp. 1506-1510 ◽

Cited By ~ 68

Author(s):

Patricia Reant ◽

Sebastien Brunot ◽

Stephane Lafitte ◽

Karim Serri ◽

Lionel Leroux ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Angiography ◽

Multidetector Computed Tomography ◽

Predictive Value ◽

Coronary Stenosis ◽

Valve Surgery ◽

Noninvasive Coronary Angiography ◽

Significant Coronary Stenosis

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Can 64-Row Computed Tomography Replace Angiography after Coronary Bypass?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230801600603 ◽

2008 ◽

Vol 16 (6) ◽

pp. 444-449 ◽

Cited By ~ 2

Author(s):

Hirosato Doi ◽

Ryuji Koshima ◽

Masato Suzuki ◽

Ken Takahashi ◽

Hiroichi Yokoyama ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Artery Bypass ◽

Graft Occlusion ◽

Diagnostic Power ◽

Multi Detector Computed Tomography

Multi-detector (64-row) computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. We compared the power of evaluation of multi-detector computed tomography with that of conventional coronary angiography in 60 patients who underwent coronary artery bypass with 135 grafts and 210 graft anastomoses. The diagnostic power of multi-detector computed tomography for graft occlusion was: 100% (2/2) sensitivity, 98.5% (131/133) specificity, 50% (2/4) positive predictive value, and 100% (133/133) negative predictive value; there were no significant differences in rates of occlusion among the different types of graft. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% (2/2) sensitivity, 95.1% (194/204) specificity, 16.6% (2/12) positive predictive value, and 100% (194/194) negative predictive value, with no significant differences among grafts. Multi-detector computed tomography permits evaluation of bypass grafts and is much less invasive for the patients.

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

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(08)70250-9 ◽

2007 ◽

Vol 2007 ◽

pp. 373-374

Author(s):

S. Abbara

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Significant Coronary Artery Disease ◽

Valve Surgery ◽

Computed Tomography Coronary Angiography ◽

Cardiac Valve ◽

Cardiac Valve Surgery ◽

Artery Disease

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The Potential Value of Hybrid Positron Emission Tomography/Dual-Source Computed Tomography Imaging in Coronary Bypass Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20111045 ◽

2011 ◽

Vol 14 (5) ◽

pp. 283 ◽

Cited By ~ 2

Author(s):

Andre Plass ◽

Maximilian Y. Emmert ◽

Oliver Gaemperli ◽

Hatem Alkadhi ◽

Philipp Kaufmann ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Myocardial Perfusion ◽

Predictive Value ◽

Bypass Surgery ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct

Background: We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.Methods: After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.Results: CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).Conclusions: Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.

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