Document Detail


Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery.
MedLine Citation:
PMID:  17045904     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We studied the diagnostic performance of 64-slice computed tomography coronary angiography (CTCA) to rule out or detect significant coronary stenosis in patients referred for valve surgery. BACKGROUND: Invasive conventional coronary angiography (CCA) is recommended in most patients scheduled for valve surgery. METHODS: During a 6-month period, 145 patients were prospectively identified from a consecutive patient population scheduled for valve surgery. Thirty-five patients were excluded because of CTCA criteria: irregular heart rhythm (n = 26), impaired renal function (n = 5), and known contrast allergy (n = 4). General exclusion criteria were: hospitalization in community hospital (n = 4), no need for CCA (n = 4), previous coronary artery bypass surgery (n = 1), or percutaneous coronary intervention (n = 4). Of the remaining 97 patients, 27 denied written informed consent. Thus, the study population comprised 70 patients (49 male, 21 female; mean age 63 +/- 11 years). RESULTS: Prevalence of significant coronary artery disease, defined as having at least 1 > or =50% stenosis per patient, was 25.7%. Beta-blockers were administered in 71%, and 64% received lorazepam. The mean heart rate dropped from 72.5 +/- 12.4 to 59.5 +/- 7.5 beats/min. The mean scan time was 12.8 +/- 1.3 s. On a per-patient analysis, the sensitivity, specificity, and positive and negative predictive values were: 100% (18 of 18; 95% confidence interval [CI] 78 to 100), 92% (48 of 52; 95% CI 81 to 98), 82% (18 of 22; 95% CI 59 to 94), and 100% (48 of 48; 95% CI 91 to 100), respectively. CONCLUSIONS: The diagnostic accuracy of 64-slice CTCA for ruling out the presence of significant coronary stenoses in patients undergoing valve surgery is excellent and allows CTCA implementation as a gatekeeper for invasive CCA in these patients.
Authors:
Willem B Meijboom; Nico R Mollet; Carlos A G Van Mieghem; Jolanda Kluin; Annick C Weustink; Francesca Pugliese; Eleni Vourvouri; Filippo Cademartiri; Ad J J C Bogers; Gabriel P Krestin; Pim J de Feyter
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2006-09-26
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  48     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-18     Completed Date:  2006-11-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1658-65     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Aged
Coronary Angiography* / standards
Coronary Stenosis / drug therapy,  epidemiology,  physiopathology,  radiography*
Female
Heart Rate / drug effects
Heart Valve Diseases / surgery*
Humans
Lorazepam / therapeutic use
Male
Middle Aged
Predictive Value of Tests
Preoperative Care*
Prevalence
Prospective Studies
Referral and Consultation
Sensitivity and Specificity
Tomography, X-Ray Computed* / standards
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 846-49-1/Lorazepam

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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