Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-02-22

AUTHORS

Marco Gatti, Guglielmo Gallone, Vittoria Poggi, Francesco Bruno, Alessandro Serafini, Alessandro Depaoli, Ovidio De Filippo, Federico Conrotto, Fatemeh Darvizeh, Riccardo Faletti, Gaetano Maria De Ferrari, Paolo Fonio, Fabrizio D’Ascenzo

ABSTRACT

ObjectiveTo evaluate the diagnostic accuracy of coronary computed tomography angiography (CCTA) for the evaluation of obstructive coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI).MethodsEMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting accuracy of CCTA for the evaluation of obstructive CAD compared with invasive coronary angiography (ICA) as the reference standard. QUADAS-2 tool was used to assess the risk of bias. A bivariate random effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive ( + LR) and negative (−LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were evaluated. Prospero registration number: CRD42021252527.ResultsFourteen studies (2533 patients) were included. In the intention-to-diagnose patient-level analysis, sensitivity and specificity for CCTA were 97% (95% CI: 94–98%) and 68% (95% CI: 56–68%), respectively, and + LR and −LR were 3.0 (95% CI: 2.1–4.3) and 0.05 (95% CI: 0.03 – 0.09), with DOR equal to 60 (95% CI: 30–121). The area under the HSROC curve was 0.96 (95% CI: 0.94–0.98). No significant difference in sensitivity was found between single-heartbeat and other CT scanners (96% (95% CI: 90 – 99%) vs. 97% (95% CI: 94–98%) respectively; p = 0.37), whereas the specificity of single-heartbeat scanners was higher (82% (95% CI: 66–92%) vs. 60% (95% CI: 46 – 72%) respectively; p < 0.0001). Routine CCTA in the pre-TAVI workup could save 41% (95% CI: 34 – 47%) of ICAs if a disease prevalence of 40% is assumed.ConclusionsCCTA proved an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI; the use of single-heartbeat CT scanners can further improve these findings.Key Points• CCTA proved to have an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI.• Routine CCTA in the pre-TAVI workup could save more than 40% of ICAs.• Single-heartbeat CT scanners had higher specificity than others in the assessment of obstructive CAD in patients referred for TAVI. More... »

PAGES

5189-5200

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00330-022-08603-y

DOI

http://dx.doi.org/10.1007/s00330-022-08603-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1145747944

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/35192010


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21 schema:description ObjectiveTo evaluate the diagnostic accuracy of coronary computed tomography angiography (CCTA) for the evaluation of obstructive coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI).MethodsEMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting accuracy of CCTA for the evaluation of obstructive CAD compared with invasive coronary angiography (ICA) as the reference standard. QUADAS-2 tool was used to assess the risk of bias. A bivariate random effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive ( + LR) and negative (−LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were evaluated. Prospero registration number: CRD42021252527.ResultsFourteen studies (2533 patients) were included. In the intention-to-diagnose patient-level analysis, sensitivity and specificity for CCTA were 97% (95% CI: 94–98%) and 68% (95% CI: 56–68%), respectively, and + LR and −LR were 3.0 (95% CI: 2.1–4.3) and 0.05 (95% CI: 0.03 – 0.09), with DOR equal to 60 (95% CI: 30–121). The area under the HSROC curve was 0.96 (95% CI: 0.94–0.98). No significant difference in sensitivity was found between single-heartbeat and other CT scanners (96% (95% CI: 90 – 99%) vs. 97% (95% CI: 94–98%) respectively; p = 0.37), whereas the specificity of single-heartbeat scanners was higher (82% (95% CI: 66–92%) vs. 60% (95% CI: 46 – 72%) respectively; p < 0.0001). Routine CCTA in the pre-TAVI workup could save 41% (95% CI: 34 – 47%) of ICAs if a disease prevalence of 40% is assumed.ConclusionsCCTA proved an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI; the use of single-heartbeat CT scanners can further improve these findings.Key Points• CCTA proved to have an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI.• Routine CCTA in the pre-TAVI workup could save more than 40% of ICAs.• Single-heartbeat CT scanners had higher specificity than others in the assessment of obstructive CAD in patients referred for TAVI.
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27 schema:keywords CCTA
28 CT scanner
29 Central
30 HSROC curve
31 LR
32 MEDLINE
33 MethodsEmbase
34 ObjectiveTo
35 PubMed/MEDLINE
36 QUADAS-2 tool
37 ROC curve
38 accuracy
39 accuracy of CCTA
40 analysis
41 angiography
42 aortic valve implantation
43 area
44 artery disease
45 assessment
46 bias
47 bivariate random-effects model
48 coronary angiography
49 coronary artery disease
50 curves
51 diagnostic accuracy
52 diagnostic odds ratio
53 differences
54 disease
55 disease prevalence
56 effects model
57 evaluation
58 excellent diagnostic accuracy
59 findings
60 hierarchical summary ROC curves
61 high specificity
62 implantation
63 intention
64 invasive coronary angiography
65 likelihood ratio
66 measurements
67 model
68 negative likelihood ratio
69 obstructive coronary artery disease
70 odds ratio
71 patient-level analysis
72 patients
73 performance measurement
74 pool
75 pooled sensitivity
76 prevalence
77 random-effects model
78 ratio
79 reference standard
80 review
81 risk
82 risk of bias
83 routine CCTA
84 scanner
85 sensitivity
86 significant differences
87 specificity
88 standards
89 study
90 summary ROC curve
91 systematic review
92 tomography angiography
93 tool
94 transcatheter aortic valve implantation
95 use
96 valve implantation
97 workup
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