Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: Comparison of accuracy, radiation dose and cost versus invasive coronary angiography

Gianluca Pontone, Daniele Andreini, Erika Bertella, Sarah Cortinovis, Saima Mushtaq, Claudia Foti, Andrea Annoni, Alberto Formenti, Andrea Baggiano, Edoardo Conte, Giovanni Ballerini, Cesare Fiorentini, Antonio L. Bartorelli, Mauro Pepi

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Abstract

Background: The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. Methods: Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. Results: The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. Conclusions: The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.

Original languageEnglish
Pages (from-to)2889-2894
Number of pages6
JournalInternational Journal of Cardiology
Volume167
Issue number6
DOIs
Publication statusPublished - 2013

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Mitral Valve Prolapse
Coronary Angiography
Radiation
Costs and Cost Analysis
Multidetector Computed Tomography
Routine Diagnostic Tests
Computed Tomography Angiography
Mitral Valve Insufficiency
Standard of Care
Thoracic Surgery
Body Mass Index

Keywords

  • Accuracy
  • Coronary artery disease
  • Cost-Effectiveness
  • Invasive coronary angiography
  • MDCT
  • Mitral valve prolapse

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{e70c755f573c4283ab218041b68047b6,
title = "Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: Comparison of accuracy, radiation dose and cost versus invasive coronary angiography",
abstract = "Background: The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. Methods: Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. Results: The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99{\%} and 93{\%}, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. Conclusions: The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.",
keywords = "Accuracy, Coronary artery disease, Cost-Effectiveness, Invasive coronary angiography, MDCT, Mitral valve prolapse",
author = "Gianluca Pontone and Daniele Andreini and Erika Bertella and Sarah Cortinovis and Saima Mushtaq and Claudia Foti and Andrea Annoni and Alberto Formenti and Andrea Baggiano and Edoardo Conte and Giovanni Ballerini and Cesare Fiorentini and Bartorelli, {Antonio L.} and Mauro Pepi",
year = "2013",
doi = "10.1016/j.ijcard.2012.07.022",
language = "English",
volume = "167",
pages = "2889--2894",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "6",

}

TY - JOUR

T1 - Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair

T2 - Comparison of accuracy, radiation dose and cost versus invasive coronary angiography

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Bertella, Erika

AU - Cortinovis, Sarah

AU - Mushtaq, Saima

AU - Foti, Claudia

AU - Annoni, Andrea

AU - Formenti, Alberto

AU - Baggiano, Andrea

AU - Conte, Edoardo

AU - Ballerini, Giovanni

AU - Fiorentini, Cesare

AU - Bartorelli, Antonio L.

AU - Pepi, Mauro

PY - 2013

Y1 - 2013

N2 - Background: The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. Methods: Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. Results: The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. Conclusions: The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.

AB - Background: The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. Methods: Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. Results: The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. Conclusions: The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.

KW - Accuracy

KW - Coronary artery disease

KW - Cost-Effectiveness

KW - Invasive coronary angiography

KW - MDCT

KW - Mitral valve prolapse

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U2 - 10.1016/j.ijcard.2012.07.022

DO - 10.1016/j.ijcard.2012.07.022

M3 - Article

C2 - 22959395

AN - SCOPUS:84883825104

VL - 167

SP - 2889

EP - 2894

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 6

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