Key result
CT coronary angiography in patients with atrial fibrillation showed high diagnostic accuracy (sensitivity 94%, 95% CI 85-98%; specificity 91%) but a 4.03 mSv higher radiation dose than sinus rhythm.
Why the study?
Does CT coronary angiography provide high diagnostic accuracy and comparable radiation dose in patients with atrial fibrillation compared to conventional coronary angiography and patients in sinus rhythm?
Systematic Review and Meta-Analysis (n=821)
Does CT coronary angiography provide high diagnostic accuracy and comparable radiation dose in patients with atrial fibrillation compared to conventional coronary angiography and patients in sinus rhythm?
Effect estimate: Sensitivity (95% CI 85%, 98%)
CT coronary angiography provides high diagnostic accuracy in patients with atrial fibrillation, though it requires a higher effective radiation dose compared to imaging in patients with normal sinus rhythm.
Supports CTCA for CAD evaluation in AF; confirms high accuracy while highlighting radiation dose for optimization in practice and trials.
PURPOSE: To determine by means of a systematic review and meta-analysis the diagnostic accuracy, associated radiation dose, and technical challenges of computed tomographic (CT) coronary angiography in patients with atrial fibrillation. MATERIALS AND METHODS: A systematic literature search was performed to compare CT angiography with conventional coronary angiography in patients with atrial fibrillation and to compare CT angiography in patients with atrial fibrillation with that in patients with sinus rhythm. The search yielded seven eligible studies (247 patients) in which CT angiography was compared with conventional coronary angiography. Six additional studies were found for the assessment of CT angiography in patients with atrial fibrillation (n = 158) and those with sinus rhythm (n = 416). Extracted data were analyzed for diagnostic accuracy parameters. Mean effective radiation doses in patients with atrial fibrillation were compared with those in patients with sinus rhythm by using the weighted mean difference method. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of the selected studies. RESULTS: At per-patient analysis of the diagnostic accuracy of CT angiography versus conventional coronary angiography, the sensitivity, specificity, positive predictive value, and negative predictive value were 94% (95% confidence interval [CI]: 85%, 98%), 91% (95% CI: 85%, 94%), 79% (95% CI: 66%, 85%), and 97.5% (95% CI: 94%, 99%), respectively. Comparison of patients with atrial fibrillation and those with sinus rhythm showed no difference in heart rate (P = .16) or number of nondiagnostic segments (P = .10). Patients with atrial fibrillation were older than those with sinus rhythm (mean age ± standard deviation, 68 years ± 10 vs 61 years ± 12, respectively; P = .001). The effective radiation dose was significantly higher in patients with atrial fibrillation than in those with sinus rhythm, with a mean difference of 4.03 mSv (95% CI: 0.97, 7.1; P = .01). CONCLUSION: CT angiography has high diagnostic accuracy in patients with atrial fibrillation but is associated with significantly higher effective radiation dose than that in patients with sinus rhythm. The older age of patients with atrial fibrillation, however, may make the risk of developing cancer less of a concern.
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Vorre et al. (2013) conducted a systematic review and meta-analysis in atrial fibrillation (n=821). CT coronary angiography vs. conventional coronary angiography and sinus rhythm patients was evaluated on per-patient diagnostic sensitivity of CT angiography versus conventional coronary angiography (Sensitivity, 95% CI 85%, 98%). CT coronary angiography in patients with atrial fibrillation showed high diagnostic accuracy (sensitivity 94%, 95% CI 85-98%; specificity 91%) but a 4.03 mSv higher radiation dose than sinus rhythm.
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