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Int J Cardiol. 2013 Sep 10;167(6):2889-94. doi: 10.1016/j.ijcard.2012.07.022. Epub 2012 Sep 5.

Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: comparison of accuracy, radiation dose and cost versus invasive coronary angiography.

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  • 1Centro Cardiologico Monzino, IRCCS, Milan, Italy. gianluca.pontone@ccfm.it

Abstract

BACKGROUND:

The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT.

METHODS:

Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost.

RESULTS:

The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B.

CONCLUSIONS:

The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Accuracy; CAD; CI; Coronary artery disease; Cost-Effectiveness; ED; EF; HR; ICA; Invasive coronary angiography; LVEDV; LVESV; MDCT; MVP; Mitral valve prolapse; NPV; PAP; PPV; Se; Sp; TTE; USD; United States Dollar; confidence interval; coronary artery disease; effective radiation dose; ejection fraction; heart rate; invasive coronary angiography; left ventricle end diastolic volume; left ventricle end systolic volume; mitral valve prolapse; multidetector computed tomography coronary angiography; negative predictive value; positive predictive value; pulmonary artery pressure; sensitivity; specificity; transthoracic echocardiography

PMID:
22959395
[PubMed - indexed for MEDLINE]
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