Xingxing S Cheng1, Suman Mohanty2, Valery Turner3, Domenico Mastrodicasa3, Simon Winther4, Dominik Fleischmann3, Jane C Tan2, William F Fearon5. 1. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA, xscheng@stanford.edu. 2. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA. 3. Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA. 4. Department of Cardiology, Regional Hospital Unit West, Herning, Denmark. 5. Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Abstract
INTRODUCTION: Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown. METHODS: We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated. RESULTS: We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87-0.99) and 0.66 (0.57-0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74-1.00) and 0.67 (0.49-0.82), respectively. CONCLUSIONS: Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.
INTRODUCTION: Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown. METHODS: We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated. RESULTS: We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87-0.99) and 0.66 (0.57-0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74-1.00) and 0.67 (0.49-0.82), respectively. CONCLUSIONS: Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.
Authors: Louis W Wang; Magid A Fahim; Andrew Hayen; Ruth L Mitchell; Laura Baines; Stephen Lord; Jonathan C Craig; Angela C Webster Journal: Cochrane Database Syst Rev Date: 2011-12-07
Authors: Jacob R Morris; M Fernanda Bellolio; Lindsey R Sangaralingham; Stephanie R Schilz; Nilay D Shah; Deepi G Goyal; Malcolm R Bell; Stephen L Kopecky; Waqas I Gilani; Erik P Hess Journal: Acad Emerg Med Date: 2016-09-07 Impact factor: 3.451
Authors: Edward J Sharples; Divaka Pereira; Shaun Summers; John Cunningham; Michael Rubens; David Goldsmith; Muhammad M Yaqoob Journal: Am J Kidney Dis Date: 2004-02 Impact factor: 8.860
Authors: Christian Tesche; Carlo N De Cecco; Stefan Baumann; Matthias Renker; Tindal W McLaurin; Taylor M Duguay; Richard R Bayer; Daniel H Steinberg; Katharine L Grant; Christian Canstein; Chris Schwemmer; Max Schoebinger; Lucian M Itu; Saikiran Rapaka; Puneet Sharma; U Joseph Schoepf Journal: Radiology Date: 2018-04-10 Impact factor: 11.105
Authors: S Winther; M Svensson; H S Jørgensen; H Birn; H E Bøtker; P Ivarsen; M Bøttcher Journal: Am J Transplant Date: 2015-12-14 Impact factor: 8.086
Authors: Simon Winther; Morten Bøttcher; Hanne S Jørgensen; Kirsten Bouchelouche; Lars C Gormsen; Anna E Oczachowska-Kulik; Niels R Holm; Hans Erik Bøtker; Per R Ivarsen; My Svensson Journal: Transplantation Date: 2016-10 Impact factor: 4.939
Authors: Penny F Whiting; Anne W S Rutjes; Marie E Westwood; Susan Mallett; Jonathan J Deeks; Johannes B Reitsma; Mariska M G Leeflang; Jonathan A C Sterne; Patrick M M Bossuyt Journal: Ann Intern Med Date: 2011-10-18 Impact factor: 25.391
Authors: Ahmed Bashir; William E Moody; Nicola C Edwards; Charles J Ferro; Jonathan N Townend; Richard P Steeds Journal: Am J Kidney Dis Date: 2015-03-06 Impact factor: 8.860
Authors: Benjamin Lidgard; Leila Zelnickv; Amanda H Anderson; Harold Feldman; Alan Go; Jiang He; Mayank Kansal; Madhumita Jena Mohanty; Rupal Mehta; Michael G Shlipak; Elsayed Soliman; Matt R Weir; Nisha Bansal Journal: Kidney360 Date: 2022-03-02