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Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation

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Abstract

Objectives

We aimed to investigate the diagnostic accuracy of a standardized computed tomography angiography (CTA) for the identification of significant coronary artery disease (CAD) in patients evaluated for transcatheter aortic valve implantation (TAVI).

Background

The diagnostic performance of CTA for the detection of CAD in patients with aortic stenosis referred for TAVI has thus far not been validated.

Methods

A consecutive series of 475 patients (194 male, mean age: 82 ± 6 years) with CTA data sets obtained during the routine diagnostic work-up before TAVI were included. A total of 6,603 coronary segments in 1,899 coronary arteries ≥1.5 mm in diameter and 271 grafts were evaluated for the presence of significant CAD defined as ≥50 % luminal narrowing. Results were compared with invasive coronary angiography as the standard of reference.

Results

Prevalence of significant CAD was 57 % (270/475), and 5,925 coronary segments (90 %) and 257 bypass grafts (95 %) were evaluable by CTA. In the per-patient analysis, sensitivity (Se), specificity, and positive and negative predictive values (NPV) were 98, 37, 67 and 94 %, respectively. CTA showed satisfactory ability to exclude significant CAD in the following subgroups: (1) patients (221/475) without prior known CAD (Se: 97 %, NPV: 97 %), (2) patients (13/475) without prior known CAD and absent coronary calcification (NPV: 100 %) and (3) bypass grafts (Se: 97 %, NPV: 99 %).

Conclusions

Comprehensive evaluation of a pre-TAVI CTA could prove to be a useful rule-out test for significant CAD in selected subgroups of patients.

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Acknowledgments

We thank Elizabeth Martinson, Ph.D., for her help in editing this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Maksymilian P. Opolski, Won-Keun Kim, Christoph Liebetrau, Claudia Walther, Johannes Blumenstein, Luise Gaede, Christian W. Hamm & Helge Möllmann

  2. Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Jörg Kempfert, Arnaud Van Linden & Thomas Walther

Authors
  1. Maksymilian P. Opolski
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  2. Won-Keun Kim
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  3. Christoph Liebetrau
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  4. Claudia Walther
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  5. Johannes Blumenstein
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  6. Luise Gaede
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  7. Jörg Kempfert
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  8. Arnaud Van Linden
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  9. Thomas Walther
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  10. Christian W. Hamm
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  11. Helge Möllmann
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Corresponding author

Correspondence to Helge Möllmann.

Additional information

M. P. Opolski and W.-K. Kim contributed equally to this work.

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Opolski, M.P., Kim, WK., Liebetrau, C. et al. Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation. Clin Res Cardiol 104, 471–480 (2015). https://doi.org/10.1007/s00392-014-0806-z

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  • DOI: https://doi.org/10.1007/s00392-014-0806-z

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