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- Title
Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology.
- Authors
Kate, Gert‐Jan R.; Caliskan, Kadir; Dedic, Admir; Meijboom, W. Bob; Neefjes, Lisan A.; Manintveld, Olivier C.; Krenning, Boudewijn J.; Ouhlous, Mohammed; Nieman, Koen; Krestin, Gabriel P.; Feyter, Pim J.
- Abstract
Aims To evaluate the accuracy of cardiac computed tomography (CT) in distinguishing CAD and non-CAD heart failure (HF) and its effectiveness as a gatekeeper for invasive coronary angiography (ICA). Methods and results We prospectively included 93 symptomatic patients with newly diagnosed HF of unknown aetiology (59 men; mean age 53 ± 13) and EF <45%, and/or fractional shortening <25%, and/or end-diastolic LV diameter >60 mm (men) or >55 mm (women). In all patients, the CT calcium score (CTCS) was determined. CTCS = 0 excluded CAD HF. Additional CT coronary angiography (CTCA) was performed if CTCS >0. ICA was used as the gold standard for distinguishing between CAD and non-CAD HF in patients with >20% luminal diameter narrowing on CTCA. CAD HF was defined as >50% luminal diameter narrowing in either (i) the left main coronary artery or proximal left anterior descending coronary artery or (ii) in multiple coronary arteries. Diagnostic accuracy and follow-up data (20 ± 16 months) were collected for all patients. CTCS = 0 ruled out CAD HF in 43 patients (46%). The CT algorithm had 100% sensitivity, 95% specificity, 67% positive predictive value, and 100% negative predictive value for detecting CAD HF. Patients with CTCS = 0 or non-CAD HF on CTCA had no coronary events during follow-up, and ICA could have been safely avoided in 76 out of 93 patients (82%). Conclusion In patients with HF of unknown aetiology, cardiac CT combining CTCS and CTCA has high accuracy for detecting CAD HF and can be used effectively as a gatekeeper for ICA.
- Subjects
CORONARY angiography; HEART failure; HEART failure patients; CARDIOGRAPHIC tomography; ETIOLOGY of diseases; CORONARY arteries; FOLLOW-up studies (Medicine); DIAGNOSIS
- Publication
European Journal of Heart Failure, 2013, Vol 15, Issue 9, p1028
- ISSN
1388-9842
- Publication type
Article
- DOI
10.1093/eurjhf/hft090