325 例连续患者经导管主动脉瓣置换术转诊行多排 CT 冠状动脉造影的诊断准确性。
Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement.
机构信息
Centro Cardiologico Monzino, IRCCS Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Centro Cardiologico Monzino, IRCCS Milan, Italy.
出版信息
Am Heart J. 2014 Sep;168(3):332-9. doi: 10.1016/j.ahj.2014.04.022. Epub 2014 Jun 9.
BACKGROUND
Multidetector computed tomography (MDCT) provides detailed assessment of valve annulus and iliofemoral vessels in transcatheter aortic valve replacement (TAVR) patients. However, data on diagnostic performance of MDCT coronary angiography (MDCT-CA) are scarce. The aim of the study is to assess diagnostic performance of MDCT for coronary artery evaluation before TAVR.
METHODS
A total of 325 consecutive patients (234 without previous myocardial revascularization, 49 with previous coronary stenting, and 42 with previous coronary artery bypass graft [CABG]) underwent invasive coronary angiography and MDCT before TAVR. MDCT-CA was performed using the same data set dedicated to standard MDCT aortic annulus evaluation. Multidetector computed tomography-CA evaluability and diagnostic accuracy in comparison with invasive coronary angiography as criterion standard were assessed.
RESULTS
The MDCT-CA evaluability of native coronaries was 95.6%. The leading cause of unevaluability was beam-hardening artifact due to coronary calcifications. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting ≥50% stenosis of 91%, 99.2%, 83.4%, 99.6% and 98.8%, respectively. The MDCT-CA evaluability of coronary stents was 82.1%. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy for detecting ≥50% in-stent restenosis of 94.1%, 86.7%, 66.7%, 98.1%, and 88.3%, respectively. All CABGs were correctly assessed by MDCT-CA. In a patient-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy of 89.7%, 90.8%, 80.6%, 95.4%, and 90.5%, respectively.
CONCLUSIONS
Multidetector computed tomography-CA allows to correctly rule out the presence of significant native coronary artery stenosis, significant in-stent restenosis, and CABG disease in patients referred for TAVR.
背景
多排螺旋计算机断层扫描（MDCT）可详细评估经导管主动脉瓣置换术（TAVR）患者的瓣环和髂股血管。然而，MDCT 冠状动脉成像（MDCT-CA）的诊断性能数据却很少。本研究旨在评估 MDCT 用于 TAVR 前冠状动脉评估的诊断性能。
方法
连续 325 例患者（234 例无先前的心肌血运重建，49 例有先前的冠状动脉支架置入，42 例有先前的冠状动脉旁路移植术[CABG]）在 TAVR 前行有创冠状动脉造影和 MDCT。MDCT-CA 使用专门用于标准 MDCT 主动脉瓣环评估的数据进行。评估了 MDCT-CA 的可评估性和与有创冠状动脉造影作为金标准的诊断准确性。
结果
MDCT-CA 对原生冠状动脉的可评估性为 95.6%。导致不可评估的主要原因是由于冠状动脉钙化引起的束硬化伪影。在节段性分析中，MDCT-CA 对检测≥50%狭窄的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为 91%、99.2%、83.4%、99.6%和 98.8%。MDCT-CA 对冠状动脉支架的可评估性为 82.1%。在节段性分析中，MDCT-CA 对检测≥50%支架内再狭窄的敏感性、特异性、PPV、NPV 和准确性分别为 94.1%、86.7%、66.7%、98.1%和 88.3%。所有 CABG 均通过 MDCT-CA 正确评估。在患者水平的分析中，MDCT-CA 的敏感性、特异性、PPV、NPV 和准确性分别为 89.7%、90.8%、80.6%、95.4%和 90.5%。
结论
MDCT-CA 可正确排除 TAVR 患者存在明显的原生冠状动脉狭窄、明显的支架内再狭窄和 CABG 疾病。
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