title: CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis.
abstract: This study aimed to evaluate the diagnostic accuracy of coronary computed tomography angiography (CTA) for detecting coronary artery stenoses in patients with valvular heart disease undergoing valve surgery.
  
  
  
  Coronary CTA is currently not routinely recommended for detecting coronary artery stenoses before cardiac valve surgery. However, recent improvements in computed tomography technology may enable the identification of the most appropriate candidates for coronary CTA before valve surgery.
  
  
  
  A systematic review was performed of PubMed, EMBASE, and the Cochrane databases for all studies that used ≥16-detector row computed tomography scanning to perform coronary CTA in patients with valvular heart disease scheduled for valve surgery and validated the results against invasive angiography. Summary diagnostic accuracies were calculated by using a bivariate random effects model, and a generalized linear mixed model was applied for heterogeneity analysis.
  
  
  
  Seventeen studies analyzing 1,107 patients and 12,851 coronary segments were included. Patient-based analysis revealed a pooled sensitivity of 93% (95% confidence interval [CI]: 86 to 97), specificity of 89% (95% CI: 86 to 91), a negative likelihood ratio (LR) of 0.07 (95% CI: 0.04 to 0.16), and a positive LR of 8.44 (95% CI: 6.49 to 10.99) for coronary CTA to identify individuals with stenosis ≥50%. Specificity and positive LR were higher in patients without aortic stenosis (AS) versus those with AS (96% vs. 87% and 21.2 vs. 7.4, respectively), as well as with ≥64 detectors versus <64 detectors (90% vs. 86% and 9.5 vs. 6.9). Heterogeneity analysis revealed a significant impact of AS and the number of detectors on specificity of CTA.
  
  
  
  Coronary CTA using currently available technology is a reliable imaging alternative to invasive angiography with excellent sensitivity and negative LR for the detection of significant coronary stenoses in patients undergoing cardiac valve surgery. The specificity of coronary CTA may be decreased against the background of AS (Computed Tomography Angiography for the Detection of Coronary Artery Disease in Patients Referred for Cardiac Valve Surgery: A Meta-Analysis; CRD42015016213).
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: opolski.mp@gmail.com.
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Staruch
authors.affiliation: Institute of Econometrics, Warsaw School of Economics, Warsaw, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Jakubczyk
authors.affiliation: Department of Radiology, The New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Department of Imaging and Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Medical University of Warsaw, Warsaw, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Staruch
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Won-Keun
authors.initials: WK
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012307:Risk Factors
keywords: coronary angiography; coronary computed tomography angiography; meta-analysis; valvular heart disease