Rasmus Bo Hasselbalch1, Thomas Engstrøm2, Mia Pries-Heje3, Merete Heitmann4, Frants Pedersen2, Morten Schou3, Hans Mickley5, Hanne Elming6, Rolf Steffensen7, Lars Køber2, Kasper Iversen3. 1. Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark. Electronic address: r.hasselbalch@gmail.com. 2. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 3. Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark. 4. Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark. 5. Department of Cardiology, Odense University Hospital, Odense, Denmark. 6. Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark. 7. Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark.
Abstract
BACKGROUND: Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG. METHODS: The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry. RESULTS: The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%. CONCLUSION: A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery.
BACKGROUND: Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG. METHODS: The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry. RESULTS: The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%. CONCLUSION: A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery.
Authors: Rasmus Bo Hasselbalch; Mia Pries-Heje; Thomas Engstrøm; Andreas Sandø; Merete Heitmann; Frants Pedersen; Morten Schou; Hans Mickley; Hanne Elming; Rolf Steffensen; Lars Koeber; Kasper Karmark Iversen Journal: Open Heart Date: 2019-10-03
Authors: Rasmus Bo Hasselbalch; Mia Marie Pries-Heje; Sarah Louise Kjølhede Holle; Thomas Engstrøm; Merete Heitmann; Frants Pedersen; Morten Schou; Hans Mickley; Hanne Elming; Rolf Steffensen; Lars Koeber; Kasper Iversen Journal: Open Heart Date: 2020-10