Elagha Abdalla, Khaled Waleed, Gamal Sahar, Helmy Mohamed, Kaddah Ayman
Cardiovascular Department, Kasr-Alainy Hospital, Cairo University, 1 Saraya St., Third Floor, Manial, Cairo, Egypt.
Cardiovascular Department, National Heart Institute, Cairo, Egypt.
Egypt Heart J. 2021 Jul 5;73(1):63. doi: 10.1186/s43044-021-00180-7.
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.
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.
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.
传统冠状动脉造影（CAG）是目前心脏瓣膜手术前评估冠状动脉的金标准技术。尽管CAG是一种相对安全的检查方法，但它仍然是一种侵入性检查，存在潜在风险和并发症。冠状动脉计算机断层扫描血管造影（CCTA）是一种非侵入性技术，已成为描绘冠状动脉解剖结构的出色且有吸引力的工具。因此，我们旨在评估在瓣膜手术前评估冠状动脉时，CCTA与金标准CAG相比的准确性。我们筛选了111例连续接受常规心脏导管检查以进行术前CAD评估的VHD患者。50例患者符合条件并接受了CAG和CCTA检查。显著冠状动脉狭窄定义为管腔直径减少≥50%。此外，还分析了血管扩张、钙化和先天性冠状动脉异常情况。同时，我们比较了两种技术在辐射剂量、对比剂用量和并发症方面的情况。所有分析层面均排除不可评估节段。61例患者因各种原因被排除在研究之外。
在研究人群的50例患者中，27例（54%）为男性。根据基于患者的分析，研究人群中显著CAD的患病率为19.6%，对于CCTA结果为真阴性的患者，80.4%的患者可避免进行CAG检查。从节段层面分析，CCTA检测显著狭窄的诊断准确性通过敏感性、特异性、阳性预测值、阴性预测值和总体准确性进行评估，分别为87.5%、99.6%、87.5%、99.6%和99.2%；从血管层面分析，分别为86%、100%、100%、99%和99%；从患者层面分析，分别为77.8%、100%、100%、94.9%和95.7%。CCTA的并发症发生率较低。CCTA在检测钙化和先天性异常等额外信息方面比CAG诊断得更好。
主要由于其高阴性预测值，一次执行良好的CCTA检查是排除冠状动脉疾病的出色方法，尤其适用于动脉粥样硬化风险不高的患者。
