title: Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  We aimed to investigate the diagnostic accuracy of a standardized computed tomography angiography (CTA) for the identification of significant coronary artery disease (CAD) in patients evaluated for transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  The diagnostic performance of CTA for the detection of CAD in patients with aortic stenosis referred for TAVI has thus far not been validated.
  
  
  METHODS
  A consecutive series of 475 patients (194 male, mean age: 82 ± 6 years) with CTA data sets obtained during the routine diagnostic work-up before TAVI were included. A total of 6,603 coronary segments in 1,899 coronary arteries ≥ 1.5 mm in diameter and 271 grafts were evaluated for the presence of significant CAD defined as ≥ 50% luminal narrowing. Results were compared with invasive coronary angiography as the standard of reference.
  
  
  RESULTS
  Prevalence of significant CAD was 57% (270/475), and 5,925 coronary segments (90%) and 257 bypass grafts (95%) were evaluable by CTA. In the per-patient analysis, sensitivity (Se), specificity, and positive and negative predictive values (NPV) were 98, 37, 67 and 94%, respectively. CTA showed satisfactory ability to exclude significant CAD in the following subgroups: (1) patients (221/475) without prior known CAD (Se: 97%, NPV: 97%), (2) patients (13/475) without prior known CAD and absent coronary calcification (NPV: 100%) and (3) bypass grafts (Se: 97%, NPV: 99%).
  
  
  CONCLUSIONS
  Comprehensive evaluation of a pre-TAVI CTA could prove to be a useful rule-out test for significant CAD in selected subgroups of patients.
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.forename: Won-Keun
authors.initials: WK
authors.lastname: Kim
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.forename: Claudia
authors.initials: C
authors.lastname: Walther
authors.forename: Johannes
authors.initials: J
authors.lastname: Blumenstein
authors.forename: Luise
authors.initials: L
authors.lastname: Gaede
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Arnaud
authors.initials: A
authors.lastname: Van Linden
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods