Computed tomographic coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial
Benjamin J W Chow1, Rachel E Green, Doug Coyle
1Department of Medicine, Division of Cardiology, (including Cardiac Imaging, The Heart Failure Program, and the Cardiac ResearchMethods Centre), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. bchow@ottawaheart.ca.
Insights
Computed tomographic coronary angiography (CTA) shows promise as a non-invasive tool for diagnosing coronary artery disease in heart failure patients, potentially offering similar outcomes to invasive methods with reduced risks and costs.
Area of Science:
- Cardiology
- Medical Imaging
- Health Economics
Background:
- Heart failure (HF) prevalence is increasing globally.
- Invasive coronary angiography (ICA) is the standard for coronary artery disease (CAD) assessment in HF, but non-invasive alternatives are needed.
- Computed tomographic coronary angiography (CTA) is a validated non-invasive tool for CAD, but its utility in HF patients is unproven.
Purpose of the Study:
- To evaluate the efficacy and cost-effectiveness of CTA versus ICA in heart failure patients requiring coronary anatomical definition.
- To assess downstream resource utilization and clinical outcomes associated with CTA versus ICA as an initial diagnostic strategy.
- To determine the accuracy of CTA in identifying coronary anatomy and obstructions in HF patients.
Main Methods:
- A multicenter randomized controlled trial enrolling 250 HF patients.
- Patients randomized to CTA or ICA (125 per group) as the primary diagnostic test.
- Primary outcomes focus on downstream resource utilization; secondary outcomes include clinical events and major adverse cardiac events.
Main Results:
- Study aims to demonstrate CTA as a more cost-effective strategy.
- Expected outcomes include similar diagnostic accuracy to ICA with fewer procedural risks.
- Anticipated improvement in resource utilization with CTA.
Conclusions:
- CTA may offer a safe, accurate, and cost-effective alternative to ICA for diagnosing CAD in HF patients.
- This approach could reduce healthcare costs and procedural risks.
- Further research is needed to confirm CTA's role in HF management.
Background:
The prevalence of heart failure (HF) is rising in industrialized and developing countries. Though invasive coronary angiography (ICA) remains the gold standard for anatomical assessment of coronary artery disease in HF patients, alternatives are being sought. Computed tomographic coronary angiography (CTA) has emerged as an accurate non-invasive diagnostic tool for coronary artery disease (CAD) and has been demonstrated to have prognostic value. Whether or not CTA can be used in HF patients is unknown. Acknowledging the aging population, the growing prevalence of HF and the increasing financial burden of healthcare, we need to identify non-invasive diagnostic tests that are available, safe, accurate and cost-effective.
Methods/Design:
The proposed study aims to provide insight into the efficacy of CTA in HF patients. A multicenter randomized controlled trial will enroll 250 HF patients requiring coronary anatomical definition. Enrolled patients will be randomized to either CTA or ICA (n = 125 per group) as the first test to define coronary anatomy. The primary outcomes will be collected to determine downstream resource utilization. Secondary outcomes will include the composite clinical events and major adverse cardiac events. In addition, the accuracy of CTA for detecting coronary anatomy and obstruction will be assessed in patients who subsequently undergo both CTA and ICA. It is expected that CTA will be a more cost-effective strategy for diagnosis: yielding similar outcomes with fewer procedural risks and improved resource utilization.
Trial Registration:
ClinicalTrials.gov, NCT01283659. Team grant #CIF 99470.
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