计算机断层血管造影术在经导管主动脉瓣植入术患者中的冠状动脉疾病诊断中的应用。
Computed Tomography Angiography for the Diagnosis of Coronary Artery Disease Among Patients Undergoing Transcatheter Aortic Valve Implantation.
机构信息
Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland.
出版信息
J Cardiovasc Transl Res. 2021 Oct;14(5):894-901. doi: 10.1007/s12265-021-10099-8. Epub 2021 Feb 4.
BACKGROUND
Computed tomography angiography (CTA) is used to plan TAVI procedures. We investigated the performance of pre-TAVI CTA for excluding coronary artery disease (CAD).
METHODS
In total 127 patients were included. CTA images were analyzed for the presence of ≥ 50% (significant CAD) and ≥ 70% (severe CAD) diameter stenoses in proximal coronary arteries. Results were compared with invasive coronary angiography (ICA) at vessel and patient levels. Primary endpoint was the negative predictive value (NPV) of CTA for the presence of CAD.
RESULTS
A total of 342 vessels were analyzable. NPV of CTA was 97.5% for significant CAD and 96.3% for severe CAD. Positive predictive value and accuracy were 44.8% and 87.1% for significant CAD and 56.3% and 94.4% for severe CAD. At patient level, NPV for significant CAD was 88.6%.
CONCLUSION
Pre-TAVI CTA shows good performance for ruling out CAD and could be used as a gatekeeper for ICA in selected patients.
背景
计算机断层血管造影（CTA）用于 TAVI 手术的规划。我们研究了 TAVI 前 CTA 排除冠状动脉疾病（CAD）的性能。
方法
共纳入 127 例患者。对近端冠状动脉≥50%（显著 CAD）和≥70%（重度 CAD）直径狭窄的 CTA 图像进行分析。结果与血管内冠状动脉造影（ICA）在血管和患者水平上进行比较。主要终点是 CTA 对 CAD 存在的阴性预测值（NPV）。
结果
共分析了 342 个血管。CTA 对显著 CAD 的 NPV 为 97.5%，对重度 CAD 的 NPV 为 96.3%。对显著 CAD 的阳性预测值和准确性分别为 44.8%和 87.1%，对重度 CAD 的阳性预测值和准确性分别为 56.3%和 94.4%。在患者水平，对显著 CAD 的 NPV 为 88.6%。
结论
TAVI 前 CTA 对排除 CAD 具有良好的性能，可作为有选择的患者进行 ICA 的筛查手段。
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