Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. (September 2013)

• Record Type: Journal Article
• Authors: ten, 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.; de, Pim J.
• Is Part Of: European journal of heart failure. Volume 15:Number 9(2013)
• Page Start: 1028
• Page End: 1034
• Publication Date: 2013-09
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1093/eurjhf/hft090
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhfhft090-sec-0001" sec-type="section"> <title>Aims</title> <p>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).</p> </sec> <sec id="ejhfhft090-sec-0002" sec-type="section"> <title>Methods and results</title> <p>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%).</p> </sec> <sec id="ejhfhft090-sec-0003" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>