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Coronary computed tomography versus coronary angiography for preoperative coronary assessment before valve surgery
Abdalla Elagha1, Waleed Khaled2, Sahar Gamal2
1Cardiovascular Department, Kasr-Alainy Hospital, Cairo University, 1 Saraya St., Third Floor, Manial, Cairo, Egypt. abdalla.elagha@kasralainy.edu.eg.
Insights
Coronary computed tomography angiography (CCTA) accurately assesses coronary arteries before valve surgery, showing high accuracy in detecting stenosis and ruling out coronary artery disease (CAD). This non-invasive method offers a safer alternative to conventional angiography, reducing unnecessary invasive procedures.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Conventional coronary angiography (CAG) is invasive and carries risks.
- Coronary computed tomography angiography (CCTA) is a non-invasive alternative for coronary anatomy assessment.
- Preoperative evaluation of coronary arteries is crucial before cardiac valve surgery.
Purpose of the Study:
- To evaluate the diagnostic accuracy of CCTA compared to CAG for coronary artery disease (CAD) in patients undergoing valve surgery.
- To compare the safety and additional diagnostic information provided by CCTA versus CAG.
Main Methods:
- Prospective study involving 50 patients with valvular heart disease (VHD) who underwent both CAG and CCTA.
- Significant coronary stenosis defined as ≥ 50% luminal diameter decrease.
- Analysis of ectasia, calcifications, congenital anomalies, radiation dose, contrast volume, and complications.
Main Results:
- CCTA demonstrated high diagnostic accuracy: overall accuracy was 99.2% (segmental), 99% (vessel), and 95.7% (patient-based).
- High negative predictive value (99.6% segmental, 99% vessel, 94.9% patient-based) allows ruling out significant CAD.
- CCTA had fewer complications and better detection of calcifications and anomalies than CAG.
Conclusions:
- CCTA is an excellent non-invasive tool for ruling out CAD in patients not at high risk for atherosclerosis.
- High negative predictive value supports CCTA's role in preoperative assessment, potentially avoiding invasive CAG.
- CCTA provides comprehensive anatomical detail with improved safety profile.
Background:
Conventional coronary angiography (CAG) is currently the gold standard technique for the assessment of coronary arteries prior to cardiac valve surgery. Although CAG is a relatively safe procedure, however, it is still an invasive procedure, and it has potential hazards and complications. Coronary computed tomography angiography (CCTA) is a non-invasive technique that has emerged robustly as an excellent and attractive tool for delineating coronary anatomy. Therefore, we sought to evaluate the accuracy of CCTA when compared with the gold standard CAG in the evaluation of coronary arteries before valve surgery. We screened 111 consecutive patients with VHD undergoing a routine cardiac catheterization for preoperative evaluation of CAD. Fifty patients were eligible and underwent both CAG and CCTA. Significant coronary stenosis was defined as a luminal diameter decrease of ≥ 50%. Additionally, ectasia, calcifications, and congenital coronary anomalies were analyzed. Also, we compared both techniques regarding radiation dose, contrast volume, and complications. Non-evaluable segments were excluded from all levels of analysis. Sixty-one patients were excluded from the study due to various reasons.
Results:
Among the 50 patients of the study population, 27 (54%) were males. The prevalence of significant CAD in the study population was 19.6% according to the patient-based analysis, and CAG could have been avoided in 80.4% of patients with a true-negative CCTA result. Diagnostic accuracy of CCTA for detection of significant stenosis was evaluated regarding sensitivity and specificity, positive predictive value, negative predictive value, and overall accuracy of CCTA, which was 87.5%, 99.6%,87.5%, 99.6%, and 99.2%, respectively, for segmental-based analysis; 86%, 100%, 100%, 99%, and 99%, respectively, for vessel-based analysis; and 77.8%,100%,100%, 94.9%, and 95.7%, respectively, for patient-based analysis. Fewer rates of complications were encountered with CCTA. Additional information obtained like calcifications and congenital anomalies was diagnosed better with CCTA than CAG.
Conclusion:
Owing mainly to its high negative predictive value, a well-performed CCTA exam is an excellent method to rule out coronary artery disease, specially in patients who are not at high risk of atherosclerosis.
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Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...