Eight-row multidetector computed tomography coronary angiography evaluation of significant coronary artery disease in patients with severe aortic valve stenosis.
BACKGROUND
The aim of this study was to evaluate whether 8-row multidetector computed tomography coronary angiography (MDCT-CA) could replace invasive conventional coronary angiography (CCA) in patients with acquired severe aortic valve stenosis (AS). Coronary artery disease (CAD) diagnosis should be obtained with a noninvasive method in patients with AS undergoing valvular replacement. We evaluated the diagnostic accuracy of MDCT-CA in detecting high-grade (> or =50%) stenoses in the main coronary arteries in patients with AS.


METHODS
Twenty-three patients with acquired severe AS underwent both CCA and MDCT-CA. We calculated the total and volumetric calcium scores and evaluated the image quality of each coronary segment as assessable or nonassessable for stenosis. The images of the arteries were evaluated for the occurrence of artifacts and the presence of high-grade stenoses (> or =50%) by visual estimation and comparison with that of CCA.


RESULTS
Of the 322 segments screened 224 were assessable for stenosis. Heavy calcium load rendered 37 (38%) of the 98 coronary segments nonassessable. Compared to CCA, MDCT-CA had a sensitivity of 63%, a specificity of 96%, a positive predictive value of 52%, and a negative predictive value of 98% for > or =50% stenoses in the main coronary arteries.


CONCLUSIONS
Eight-row MDCT-CA revealed a low sensitivity in detecting significant coronary artery disease in patients with acquired severe AS. High calcium burden decreased visualization of the lumen and complicated most often a correct assessment. In this patient group, CCA should still remain the primary pre-surgical test to rule out coronary lesions requiring revascularization.
Holmström
Miia
M
Helsinki Medical Imaging Center, Helsinki University Central Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland. Miia.holmstrom@hus.fi
Sillanpää
Mikko A
MA
Kupari
Markku
M
Kivistö
Sari
S
Lauerma
Kirsi
K
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed