Diagnostic Accuracy of Coronary Computed Tomography before Aortic Valve Replacement: Systematic Review and Meta-Analysis

Kongkiat Chaikriangkrai, Hye Yeon Jhun, Ghanshyam Palamaner Subash Shantha, Aref Bin Abdulhak, Rudhir Tandon, Musab Alqasrawi, Anthony Klappa, Samir Pancholy, Abhishek Deshmukh, Jay Bhama, Gardar Sigurdsson

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Purpose: In aortic stenosis patients referred for surgical and transcatheter aortic valve replacement (AVR), the evidence of diagnostic accuracy of coronary computed tomography angiography (CCTA) has been limited. The objective of this study was to investigate the diagnostic accuracy of CCTA for significant coronary artery disease (CAD) in patients referred for AVR using invasive coronary angiography (ICA) as the gold standard. Materials and Methods: We searched databases for all diagnostic studies of CCTA in patients referred for AVR, which reported diagnostic testing characteristics on patient-based analysis required to pool summary sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio. Significant CAD in both CCTA and ICA was defined by >50% stenosis in any coronary artery, coronary stent, or bypass graft. Results: Thirteen studies evaluated 1498 patients (mean age, 74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of significant stenosis determined by ICA was 43%. Hierarchical summary receiver-operating characteristic analysis demonstrated a summary area under curve of 0.96. The pooled sensitivity, specificity, and positive-likelihood and negative-likelihood ratios of CCTA in identifying significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06, respectively. In subgroup analysis, the diagnostic profiles of CCTA were comparable between surgical and transcatheter AVR. Conclusions: Despite the higher prevalence of significant CAD in patients with aortic stenosis than with other valvular heart diseases, our meta-analysis has shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for ICA. Our study illustrates a need for further study of the potential role of CCTA in preoperative planning for AVR.

Original languageEnglish (US)
Pages (from-to)207-216
Number of pages10
JournalJournal of Thoracic Imaging
Volume33
Issue number4
DOIs
StatePublished - Jul 1 2018

Keywords

  • aortic stenosis
  • cardiac surgery
  • computed angiography
  • coronary artery disease
  • preoperative
  • transcatheter aortic valve replacement
  • valvular heart disease

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