title: Accuracy of multislice computed tomography in the preoperative assessment of coronary disease in patients scheduled for heart valve surgery.
abstract: BACKGROUND
  Coronary angiography (CA), an invasive and expensive procedure, is still recommended in most patients referred for elective valve surgery. Multislice computed tomography (MSCT) is a promising alternative technique to rule out significant coronary artery lesions.
  
  
  OBJECTIVE
  To evaluate MSCT in detecting significant coronary artery lesions in patients referred for elective valve surgery.
  
  
  METHODS
  Between August 2007 and December 2010, patients referred for elective valve surgery were identified prospectively and underwent 64-slice MSCT and CA. We compared significant coronary stenoses, defined as a reduction of luminal diameter ≥ 50%, to establish the diagnostic accuracy of MSCT. All coronary segments were analysed and uninterpretable lesions were scored positive.
  
  
  RESULTS
  Forty-eight patients were included (62.5% male; mean age 65 ± 12 years), the majority had aortic insufficiency (37.7%) or aortic stenosis (32.0%). The prevalence of significant coronary artery stenoses was 27.1%. The sensitivity, specificity, positive and negative predictive values of MSCT were 77%, 89%, 71% and 91%, respectively, in a patient-based analysis; 82%, 86%, 64% and 94% in a revascularization-based analysis; 67%, 94%, 52% and 97% in a vessel-based analysis; and 65%, 98%, 52% and 99% in a segment-based analysis. Overall, CA could have been avoided in 65% of patients.
  
  
  CONCLUSIONS
  In patients referred for elective valve surgery, MSCT had a high diagnostic accuracy to rule out significant coronary stenoses. However, larger multicenter studies in an unselected population of patients are needed to determine its place within the range of diagnostic tool in the preoperative assessment of valvular heart disease.
authors.affiliation: Hôpital privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France. redjack@hotmail.fr
authors.forename: Réda
authors.initials: R
authors.lastname: Jakamy
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Claude
authors.initials: C
authors.lastname: Le Feuvre
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Berman
authors.forename: Rhéda
authors.initials: R
authors.lastname: Boutekadjirt
authors.forename: Philippe
authors.initials: P
authors.lastname: Cluzel
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Metzger
authors.forename: Gérard
authors.initials: G
authors.lastname: Helft
mesh_terms: D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity