title: Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology.
abstract: OBJECTIVE
  To evaluate the accuracy of cardiac computed tomography (CT) in distinguishing CAD and non-CAD heart failure (HF) and its effectiveness as a gatekeeper for invasive coronary angiography (ICA).
  
  
  RESULTS
  We prospectively included 93 symptomatic patients with newly diagnosed HF of unknown aetiology (59 men; mean age 53 ± 13) and EF <45%, and/or fractional shortening <25%, and/or end-diastolic LV diameter >60 mm (men) or >55 mm (women). In all patients, the CT calcium score (CTCS) was determined. CTCS = 0 excluded CAD HF. Additional CT coronary angiography (CTCA) was performed if CTCS >0. ICA was used as the gold standard for distinguishing between CAD and non-CAD HF in patients with >20% luminal diameter narrowing on CTCA. CAD HF was defined as >50% luminal diameter narrowing in either (i) the left main coronary artery or proximal left anterior descending coronary artery or (ii) in multiple coronary arteries. Diagnostic accuracy and follow-up data (20 ± 16 months) were collected for all patients. CTCS = 0 ruled out CAD HF in 43 patients (46%). The CT algorithm had 100% sensitivity, 95% specificity, 67% positive predictive value, and 100% negative predictive value for detecting CAD HF. Patients with CTCS = 0 or non-CAD HF on CTCA had no coronary events during follow-up, and ICA could have been safely avoided in 76 out of 93 patients (82%).
  
  
  CONCLUSIONS
  In patients with HF of unknown aetiology, cardiac CT combining CTCS and CTCA has high accuracy for detecting CAD HF and can be used effectively as a gatekeeper for ICA.
authors.affiliation: Department of Cardiology, Thorax Centre Rotterdam, The Netherlands. g.tenkate@erasmusmc.nl
authors.forename: Gert-Jan R
authors.initials: GJ
authors.lastname: ten Kate
authors.forename: Kadir
authors.initials: K
authors.lastname: Caliskan
authors.forename: Admir
authors.initials: A
authors.lastname: Dedic
authors.forename: W Bob
authors.initials: WB
authors.lastname: Meijboom
authors.forename: Lisan A
authors.initials: LA
authors.lastname: Neefjes
authors.forename: Olivier C
authors.initials: OC
authors.lastname: Manintveld
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Krenning
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ouhlous
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT calcium score; Computed tomography; Coronary angiography; Coronary artery disease; Heart failure; Invasive coronary angiography