Coronary Evaluation by Computed Tomography versus Coronary Angiography in Patients undergoing Valve Surgery

Abstract

Objective: To assess the efficacy of coronary computed tomography angiography (CCTA) for coronary evaluation in patients undergoing valvular surgery, using invasive coronary angiography as the gold standard.

Study Design and Setting: Prospective study conducted in the Department of Cardiology, CPEIC Multan, from September 2022 to September 2023.

Material and Methods: A total of 100 patients with valvular heart disease undergoing preoperative coronary evaluation were included. All patients underwent CCTA and coronary angiography within 7 days of admission. Angiography was performed by cardiologists with at least 10 years of catheterization experience, via the common femoral or radial artery. CCTA was performed using a dual-source 64-slice CT system with non-ionic, low-osmolar contrast. Each of the 18 coronary segments was evaluated separately, the main coronary arteries were assessed as a whole, and significant stenosis was evaluated per patient.

Results: Of 1800 segments evaluated, 270 were excluded as absent, leaving 1530 for final comparison. On CCTA, 1056 (68.3%) were normal, 459 (30%) had insignificant stenosis, 77 (5%) had significant stenosis, and 10 (0.6%) were completely occluded.

For detecting significant stenosis at the segment level, CCTA showed a sensitivity of 88.3%, specificity of 98.5%, positive predictive value of 86.6%, negative predictive value of 98.5%, and overall accuracy of 98.9%.

At the vessel level, overall sensitivity was 85%, specificity and positive predictive value were 100%, and negative predictive value was 98%, with an overall accuracy of 98%.

Conclusion: CCTA has high diagnostic accuracy for detecting coronary artery disease and stenosis in patients before valvular surgery.

Keywords: Angiography, Computed tomography, Stenosis, Valvular disease