Evidence map›Paper›PMID 35436856›Full record

ArticleBMC cardiovascular disorders2022

Diagnostic performance of quantitative coronary artery disease assessment using computed tomography in patients with aortic stenosis undergoing transcatheter aortic-valve implantation.

Daniel Malebranche, Maximilian K M Hoffner, Adrian T Huber, Aleksandar Cicovic, Giancarlo Spano, Benedikt Bernhard, Joanna Bartkowiak, Taishi Okuno, Jonas Lanz, Lorenz Räber and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC cardiovascular disorders, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
3.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 19 citations in OpenAlex.

  1. Article
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  6. Combined CT Coronary Artery Assessment and TAVI Planning.Diagnostics (Basel, Switzerland) · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 1 institution in 1 country.

Daniel Malebranche *Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Maximilian K M Hoffner *Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
Adrian T HuberDepartment of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
Aleksandar CicovicDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Giancarlo SpanoDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Benedikt BernhardDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Joanna BartkowiakDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Taishi OkunoDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Jonas LanzDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Lorenz RäberDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Fabien PrazDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Stefan StorteckyDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Stephan WindeckerDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Thomas PilgrimDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Christoph GräniDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. christoph.graeni@insel.ch.ORCID 0000-0001-6029-0597
University of Bern · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundComputed tomography angiography (CTA) is a cornerstone in the pre- transcatheter aortic valve replacement (TAVI) assessment. We evaluated the diagnostic performance of CTA and coronary artery calcium score (CACS) for CAD evaluation compared to invasive coronary angiography in a cohort of TAVI patients.

methodsIn consecutive TAVI patients without prior coronary revascularization and device implants, CAD was assessment by quantitative analysis in CTA. (a) Patients with non-evaluable segments were classified as obstructive CAD. (b) In patients with non-evaluable segments a CACS cut-off of 100 was applied for obstructive CAD. The reference standard was quantitative invasive coronary angiography (QCA, i.e. ≥ 50% stenosis).

results100 consecutive patients were retrospectively included, age was 82.3 ± 6.5 years and 30% of patients had CAD. In 16% of the patients, adequate visualization of the entire coronary tree (all 16 segments) was possible with CTA, while 84% had at least one segment which was not evaluable for CAD analysis due to impaired image quality. On a per-patient analysis, where patients with low image quality were classified as CAD, CTA showed a sensitivity of 100% (95% CI 88.4-100.0), specificity of 11.4% (95% CI 5.1-21.3), PPV of 32.6% (95% CI 30.8-34.5), NPV of 100% and diagnostic accuracy of 38% (95% CI 28.5-48.3) for obstructive CAD. When applying a combined approach of CTA (in patients with good image quality) and CACS (in patients with low image quality), the sensitivity and NPV remained at 100% and obstructive CAD could be ruled out in 20% of the TAVI patients, versus 8% using CTA alone.

conclusionIn routinely acquired pre-TAVI CTA, the image quality was insufficient in a high proportion of patients for the assessment of the entire coronary artery tree. However, when adding CACS in patients with low image quality to quantitative CTA assessment in patients with good image quality, obstructive CAD could be ruled-out in 1/5 of the patients and may therefore constitute a strategy to streamline pre-procedural workup, and reduce risk, radiation and costs in selected TAVI patients without prior coronary revascularization or device implants.

Indexed as

Aortic Valve StenosisCoronary Artery DiseaseCoronary StenosisTranscatheter Aortic Valve ReplacementAgedAged, 80 and overComputed Tomography AngiographyCoronary AngiographyHumansRetrospective StudiesCADComputed tomography angiographyCoronary artery diseaseCTAInvasive angiographyQCATAVITranscatheter aortic valve replacement

Identifiers

PMID35436856
PMCPMC9014581
OpenAlexW4225753254

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.