title: Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: comparison of accuracy, radiation dose and cost versus invasive coronary angiography.
abstract: BACKGROUND
  The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT.
  
  
  METHODS
  Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost.
  
  
  RESULTS
  The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B.
  
  
  CONCLUSIONS
  The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. gianluca.pontone@ccfm.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.forename: Erika
authors.initials: E
authors.lastname: Bertella
authors.forename: Sarah
authors.initials: S
authors.lastname: Cortinovis
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.forename: Claudia
authors.initials: C
authors.lastname: Foti
authors.forename: Andrea
authors.initials: A
authors.lastname: Annoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Formenti
authors.forename: Andrea
authors.initials: A
authors.lastname: Baggiano
authors.forename: Edoardo
authors.initials: E
authors.lastname: Conte
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ballerini
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000191:economics / Q000592:standards*; D003365:Costs and Cost Analysis / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D061330:Multidetector Computed Tomography / Q000191:economics / Q000592:standards*; D011300:Preoperative Care / Q000191:economics / Q000592:standards*; D011829:Radiation Dosage; D012017:Referral and Consultation / Q000191:economics / Q000592:standards*