Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis

Figures

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  Fig. 1. Flow diagram

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  Fig. 2. Quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool for risk of bias and applicability concern. Green represents low; yellow, high; and blue, unclear risk. On the top panel, QUADAS-2 was reported for each study and summarized in a bar graph on the bottom panel by stacked bars for each item

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  Fig. 3. Summary forest plot is shown as paired plots, with sensitivity and specificity paired (a). HSROC plot at a patient-based level considering positive the nonvaluable segments with confidence and prediction regions around mean operating sensitivity and specificity point (b)

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  Fig. 4. a The conditional probability modifying plot is a graphical sensitivity analysis of predictive value along a prevalence continuum designating low-risk to high-risk populations. It shows distinct curves for positive and negative testing. The user draws a vertical line from the chosen pre-test probability to the appropriate likelihood ratio line, then reads the post-test probability from the vertical scale. b The likelihood ratio scattergram represents the summary point of likelihood ratios calculated as functions of mean sensitivity and specificity. The summary point is located in the left lower quadrant: the CCTA has a likelihood ratio positive < 10 and a likelihood ratio negative < 0.1. Based on these considerations, the CCTA in patients referred for TAVI is useful for exclusion of CAD (when negative) rather than confirmation (when positive). c, d Fagan’s nomograms, with estimated pretest probability of 40% and 15%, respectively. A Fagan plot has a vertical axis on the left with the prior log-odds, a vertical axis in the middle with the log-likelihood ratio, and a vertical axis on the right with the posterior log-odds. The lines are then traced from the prior probability on the…

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  Fig. 5. CCTA’s estimated impact in 1000 patients referred for TAVI. The numbers in brackets represent 95% confidence intervals

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  Fig. 6. Impact of high temporal resolution CT scanners (i.e., dual-source CTs) (a), whole-heart coverage CT scanner (b), and single-heartbeat CT scanner (c) in 1000 patients referred for TAVI. The numbers in brackets represent 95% confidence intervals