The Simultaneous Assessment of Aortic Valve Area and Coronary Artery Stenosis Using 16-Slice Multidetector-Row Computed Tomography in Patients With Aortic StenosisComparison With Echocardiography

Abstract

he method of 16-slice multidetector-row computed tomography (16-slice MDCT) has recently been introduced for the non-invasive visualization of arteriosclerotic coronary arteries, abnormal cardiac structures and myocardial properties. [1][2][3][4][5][6][7] Single-center studies have reported sensitivities between 72% and 95% and specificities between 86% and 97% for the detection of obstructive coronary lesions using 16-slice MDCT. 1-4 Multidetector-row computed tomography (MDCT) is a promising non-invasive technique for the detection of obstructive epicardial coronary artery disease (CAD).In industrialized countries the most frequent cause of aortic stenosis (AS) is degenerative changes of valve leaflets, such as the congenital bicuspid aortic valve (AV) 8 and atherosclerotic valves. These changes frequently occur in elderly patients, who are also at high risk for CAD. Severe AS (an AV area (AVA) of less than 1.0 cm 2 ) accompanied by CAD presents problems for surgical decision-making in Circulation Journal Vol.71, October 2007 whether AV replacement (AVR) should be performed with coronary artery bypass graft (CABG) surgery. 9 Transthoracic echocardiography (TTE) is an important and non-invasive method for assessing the significance of cardiac murmurs, which are derived from diseased heart valves. For diagnosing and evaluating the AVA by 2-dimensional echocardiography (DE) in patients with AS, the planimetric method without disturbed visualizations and the Doppler approach using an adequate angle of ultrasound beam are highly sensitive. [10][11][12][13] The high spatial and temporal resolution of 16-slice MDCT might allow for detailed images of the AV orifice and measurements of the AVA.The purpose of the present study is to investigate whether the AVA in patients with AS assessed by 16-slice MDCT corresponds to that by echocardiographic assessment and to evaluate simultaneously the clinical accuracy in detecting CAD with 16-slice MDCT. Methods SubjectsThe study population consisted of 29 consecutive patients (15 male, 14 female; mean age 71.0±10.6 years) who underwent TTE for the evaluation of AS. All subjects were examined by 16-slice MDCT for calculating AVA within a 1-week period following 2-DE. No change in the patients' provide for non-invasive assessment of not only coronary artery disease (CAD), but also myocardial properties and the anatomy of the whole heart. The purpose of the present study was to investigate whether the aortic valve area (AVA) in patients with aortic stenosis (AS) assessed by 16-slice MDCT corresponds to echocardiographic assessment and to evaluate simultaneously the clinical accuracy in detecting CAD with 16-slice MDCT. Methods and ResultsThe AVA of 29 consecutive AS patients with transthoracic echocardiography (TTE) and 16-slice MDCT were analyzed. The AVA was estimated by means of the continuity equation method in 2-dimensional echocardiography (DE) and the quantitative planimetric method after multi-planar reformation in 16-slice MDCT. Concomitantly, the severity of the corona...

CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery

“…After exclusion of duplicates, the systematic review retrieved 9,379 potentially relevant papers that were screened according to title or abstract for possible inclusion ( Figure 1). Thirty-four full-text reports were selected for further evaluation, from which 17 studies were excluded for the following reasons: no systematic ICA was performed (9 papers)-it was either completely absent (31,32) or was used only to confirm abnormal and/or nondiagnostic CTA findings (33)(34)(35)(36)(37)(38)(39); data to calculate diagnostic accuracies were not provided or could not be derived (4 papers) (40)(41)(42)(43); no reference to valve surgery was present (1 paper) (43); and a heterogeneous patient population inclusive of patients without VHD was included (4 papers) (44)(45)(46)(47) or no values for true-positive and false-negative observations were reported (i.e., variance is infinite and CIs as well as sensitivity could not be computed) (2 papers) (44,45). Seventeen studies were included in the final analysis ( years; 61% male) at least a 64-slice CTA was used (4,7,8,10,11,13,14,(18)(19)(20), whereas 7 studies evaluated 16-or 40-slice CTA in a total of 392 patients (mean age 68.0 AE 3.1 years; 59% male) (5,6,9,12,(15)(16)(17).…”

Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography

“…Beta-blocker use prior to MDCT was also identified in 8 of 9 studies. One study did not identify whether study subjects used BBlockers prior to study [24].…”

Clinical Implication of Energy Loss Coefficient in Patients With Severe Aortic Stenosis Diagnosed by Doppler Echocardiography

“…In addition, clinical study suggests that all measurable increase of pressure occurs within the ascending aorta. 24,25 Therefore, the measurement technique used in this study should reflect pressure recovery to a great extent.…”