Department of Cardiology and Pneumology, Heart Center, Georg August University, Robert-Koch-Strasse 40, Göttingen, Germany.
Eur Heart J Cardiovasc Imaging. 2012 Mar;13(3):263-70. doi: 10.1093/ejechocard/jer277. Epub 2011 Dec 6.
Aim of our study was to investigate the value of multidetector computed tomography (MDCT) for detecting significant stenoses of coronary arteries in patients with symptomatic atrial fibrillation (AF) prior to pulmonary vein (PV) ablation (PVA).
Many patients undergoing PVA for AF receive three-dimensional computed tomography or magnetic resonance tomography imaging for improving anatomical orientation.
One-hundred and eighty-one patients with AF refractory to antiarrhythmic treatment underwent ECG-gated 64-MDCT for identification of PV anatomy and simultaneous assessment of coronary vessels before PVA. No additional radiation was incurred for MDCT coronary angiography during MDCT scan. Pretest probability for obstructive coronary artery disease (CAD) was estimated. Invasive coronary angiography (ICA) was performed in all patients with at least intermediate risk of CAD.
Eighty-six out of 181 patients (48%) had ICA and MDCT, 95 patients (52%) underwent MDCT alone. ICA revealed significant stenoses in 9% of the catheterized patients (8/86). MDCT investigation lead to a sensitivity of 90% (9/10), specificity of 98% (829/844 lesions), positive predictive value (PPV) of 39% (9/24), and negative predictive value (NPV) of 100% (829/830 lesions) for the detection of >50% stenoses seen on ICA. All patients with a significant stenosis were classified as patients with CAD. Overall prevalence of significant CAD detected by MDCT was found to be low with 10% of patients and 2% of all segments.
MDCT coronary angiography is sensitive and highly specific in patients presenting for PVA. In this group a negative scan reliably excludes significant CAD. These data suggest that MDCT coronary angiography can replace ICA prior to PVA.
我们的研究目的是在接受肺静脉（PV）消融（PVA）的有症状心房颤动（AF）患者中，研究多排螺旋 CT（MDCT）在检测冠状动脉显著狭窄中的价值。
许多接受 AF 行 PVA 的患者接受三维 CT 或磁共振断层成像，以改善解剖定位。
181 例对心律失常治疗有反应的 AF 患者接受 ECG 门控 64-MDCT 以识别 PV 解剖结构，并在 PVA 前同时评估冠状动脉血管。在 MDCT 扫描期间，进行 MDCT 冠状动脉造影不会增加额外的辐射。对阻塞性冠状动脉疾病（CAD）的术前概率进行评估。所有 CAD 风险至少为中度的患者均进行有创冠状动脉造影（ICA）。
181 例患者中有 86 例（48%）进行了 ICA 和 MDCT，95 例（52%）仅进行了 MDCT。ICA 在接受导管治疗的患者中发现了 9%的显著狭窄（8/86）。MDCT 检查的敏感性为 90%（9/10），特异性为 98%（829/844 节段），阳性预测值（PPV）为 39%（9/24），阴性预测值（NPV）为 100%（829/830 节段），用于检测 ICA 所见 >50%狭窄。所有有显著狭窄的患者均被归类为 CAD 患者。通过 MDCT 检测到的显著 CAD 的总患病率较低，为 10%的患者和 2%的所有节段。
MDCT 冠状动脉造影在接受 PVA 的患者中具有较高的敏感性和特异性。在该组患者中，阴性扫描可可靠排除显著 CAD。这些数据表明，MDCT 冠状动脉造影可替代 PVA 前的 ICA。
