Abstract 3714: Can Multidetector Computed Tomography Replace Coronary Angiography in the Preoperative Evaluation of Patients Undergoing Valve Surgery?
Background. Pre-operative identification of significant coronary artery disease (CAD) in patients scheduled to undergo valvular surgery still requires invasive coronary angiography. Multidetector-CT (MDCT) is a promising new technique in the evaluation of such patients. The aim of this study was to evaluate the ability of MDCT to detect significant CAD prior to surgery.
Methods. Seventy-three patients (47 males, mean age: 60±13 yrs) scheduled to undergo aortic root surgery (n=23), mitral valve repair (n=23) or aortic valve replacement (n= 27) underwent 40-slice-MDCT before scheduled invasive coronary angiography. Diagnostic accu-rary of MDCT to identify >50% luminal diameter stenosis in coronary arteries was assessed on both per vessel and per patient basis.
Results. According to invasive data, 27 coronary vessels had > 50% stenosis. Fifty-nine pts were free of any CAD and 14 patients had CAD (4 1-vessel, 7 2-vessels and 3 3-vessels disease). On a per-vessel basis, MDCT correctly identified CAD in 26/27 (sensitivity 96%) vessels, and excluded it in 174/192 vessels (specificity 91%). Positive and negative predictive values and overall diagnostic accuracy on per-vessel basis were respectively 57%, 100% and 93%. On a per patient basis, all 14 patients with CAD were correctly identified (sensitivity 100%). On the other hand, MDCT correctly excluded CAD in 50/59 patients without CAD by invasive angiography (specificity 85%). Positive and negative predictive values of MDCT were 61% and 100%. Selecting patients to undergo invasive angiography only in pts with an abnormal MDCT would have saved invasive angiography in 50/73 (68%) patients prior to cardiac sugery.
Conclusion. MDCT could be potentially useful in the preoperative evaluation of pts with valvular disease. By selecting only those patients with coronary lesions to undergo invasive coronary angiography, it could avoid cardiac catheterization in a large number of patients without CAD.