Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials

D’Ascenzo, Fabrizio; Cerrato, Enrico; Biondi‐Zoccai, Giuseppe; Omedè, Pierluigi; Sciuto, Filippo; Presutti, Davide Giacomo; Quadri, Giorgio; Raff, Gilbert; Goldstein, James A.; Litt, Harold; Frati, Giacomo; Reed, Matthew J; Moretti, Claudio; Gaïta, Fiorenzo

doi:10.1093/ehjci/jes287

Cited by 48 publications

(40 citation statements)

References 56 publications

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“…However, the meta-analysis had some limitations, such as the absence of long-term followup and economic analysis of all studies. Thus, we must view the results objectively (22).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Yin¹,

Wang²,

Zheng³

et al. 2016

J. Thorac. Dis.

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Background: Both coronary computed tomography angiography (CCTA) and exercise electrocardiography (ExECG) are non-invasive testing methods for the evaluation of coronary artery disease (CAD). However, there was controversy on the diagnostic performance of these methods due to the limited data in each single study. Therefore, we performed a meta-analysis to address these issues. Methods: We searched PubMed and Embase databases up to May 22, 2015. Two authors identified eligible studies, extracted data and accessed quality. Pooled estimation of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver-operating characteristic curve (SROC) and the area under curve (AUC) of CCTA and ExECG for the diagnosis of CAD were calculated using Stata, Meta-Disc and Review Manager statistical software. and 0.7727±0.0638, respectively. There is no heterogeneity caused by threshold effect in CCTA or ExECG analysis. The Deeks' test showed no potential publication bias (P=0.17).Conclusions: CCTA has better diagnostic performance than ExECG in the evaluation of CAD, which can provide a better solution for the clinical problem of the diagnosis for CAD. J Thorac Dis 2016;8(7):1688-1696 jtd.amegroups.com standard for assessing anatomical stenosis severity, a variety of non-invasive testing methods have been advocated recently to provide an anatomic and/or functional evaluation of coronary artery. Available methods include exercise/stress electrocardiography (ExECG), single proton emission computed tomography (SPECT), myocardial perfusion imaging (MPI), coronary computed tomography angiography (CCTA) and coronary computed tomography with fractional flow reserve (FFRCT). Despite these facts, assessment of the presence of CAD remains challenging.Among these diagnostic methods, ExECG is a wellestablished and inexpensive procedure to evaluate intermediate risk patients with angina pectoris (2). However, ExECG has relatively limited diagnostic performance in patients with silent CAD (3). As a new non-invasive alternative test, CCTA has high diagnostic performance to rule out CAD (4,5). Moreover, CCTA can be used in patients with equivocal stress test or unable to exercise stress test (6). But this method also suffers a number of limitations, such as a progressive loss of sensitivity and specificity as the pretest probability of disease decreases (7).To date, several studies have compared the effectiveness of CCTA with that of ExECG for the diagnosis of CAD (8)(9)(10)(11)(12)(13)(14). But there was controversy about the specificity of two arms (12,13). Additionally, a major limitation of these investigations was their reliance, by necessity, on observational studies due to the limited data in each single study. Therefore, we performed a meta-analysis to compare the diagnostic performance of CCTA and ExECG for CAD based on a larger data, which indicates a more specific comparison about the value of anatomic and functional evaluation in clinical decisions. Methods ...

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“…However, the meta-analysis had some limitations, such as the absence of long-term followup and economic analysis of all studies. Thus, we must view the results objectively (22).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Yin¹,

Wang²,

Zheng³

et al. 2016

J. Thorac. Dis.

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“…Inclusion criteria were: 1) elevation of hs-cTn levels above the upper limit of reference at baseline and 2) renal clearance below 60 mL/min/m 2 , elaborated according to Modification of Diet in Renal Disease (MDRD) formula [15].…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

“…Age, gender, cardiovascular risk factors and renal clearance on admission (elaborated through MDRD formula [15]) were also collected. Cardiovascular risk factors were appraised during ED or cardiology ward stay as part of usual care, according to current guidelines for hypertension, hyperlipidemia and diabetes mellitus (both already known and new diagnosis) [18][19][20].…”

Section: Clinical Variables and End Pointsmentioning

confidence: 99%

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High sensitive TROponin levels In Patients with Chest pain and kidney disease: A multicenter registry — The TROPIC study

et al. 2017

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Background: Accuracy of high sensitive troponin (hs-cTn) to detect coronary artery disease (CAD) in CAD (0.2 ± 0.8 vs. 8.9 ± 4.6 ng/mL; p = 0.04) and AUC was more accurate for troponin I than hs-cTnT (AUC 0.85 vs. 0 CAD or thrombus (0.4 ± 0.6 vs. 15 ± 20 ng/mL; p = 0.02;; no differences were found for troponin T assays (0.8 ± 1.5 vs. 2.2 ± 3.6 ng/mL; p = 1.7),. Peak troponin levels (both T and I) (Cardiol J 2017; 24, 2: 139-150) .69). Peak level was greater for hs-cTnI in patients with

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“…87 Coronary MDCT in patients with HF has a high negative predictive value to confirm in a non-invasive way the absence of CAD, [88][89][90][91][92][93][94] especially in new-onset HF patients. Taking into account the significance of CAD in HF patients, MDCT may be one of the most important non-invasive tests to perform in these patients.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Novel Imaging Techniques for Heart Failure

Melero-Ferrer

López‐Vilella

Morillas-Climent

et al. 2016

Cardiac Failure Review

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Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

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Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials

Cited by 48 publications

References 56 publications

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

High sensitive TROponin levels In Patients with Chest pain and kidney disease: A multicenter registry — The TROPIC study

Novel Imaging Techniques for Heart Failure

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