Key result
64-MDCT coronary angiography demonstrated 73% sensitivity and 97% specificity for detecting aortic regurgitation, with sensitivity improving to 95% for moderate and severe cases.
Why the study?
Does 64-MDCT accurately diagnose aortic regurgitation compared to transthoracic echocardiography in patients referred for CT coronary angiography?
Cross-Sectional (n=81)
Does 64-MDCT accurately diagnose aortic regurgitation compared to transthoracic echocardiography in patients referred for CT coronary angiography?
Effect estimate: Sensitivity 73%, Specificity 97%
64-MDCT accurately detects moderate and severe aortic regurgitation, though mild regurgitation may be missed in patients with severe valve calcification or bicuspid valves.
May support 64-MDCT for moderate-severe AR during coronary CTA; leaves open prospective validation versus TTE.
OBJECTIVE: In clinical practice, 64-MDCT coronary angiography is increasingly being used for exclusion of coronary artery disease. Therefore, the purpose of this study was to evaluate whether aortic valve regurgitation can be diagnosed with 64-MDCT in comparison with transthoracic echocardiography. MATERIALS AND METHODS: Eighty-one consecutive patients were examined with ECG-gated CT coronary angiography using image reconstruction during end-diastole. The diagnostic criterion for aortic valve regurgitation by CT was an incomplete coadaptation of aortic valve leaflets, the central aortic regurgitation area (ARA), which was quantified. All patients underwent transthoracic echocardiography using semiquantitative grading of aortic valve regurgitation (i.e., mild, moderate, or severe). RESULTS: Of the 81 patients, 45 had aortic valve regurgitation by transthoracic echocardiography. The diagnostic accuracy of CT in detecting aortic valve regurgitation was as follows: sensitivity of 73% (33/45), specificity of 97% (35/36), positive predictive value (PPV) of 97% (33/34), and negative predictive value (NPV) of 74% (35/47). All 12 false-negative findings by CT were graded as mild regurgitation by transthoracic echocardiography and were caused by severe valve calcification (mean, 3,053.1 +/- 1,700 Agatston units; range, 937.7-5,632.5 Agatston units), bicuspid valves, or both. The sensitivity, specificity, PPV, and NPV of CT for the detection of moderate and severe aortic valve regurgitation were 95%, 100%, 100%, and 98%, respectively. Quantification of the ARA by CT (mean, 0.25 cm(2) +/- 0.34 cm(2) [SD]) was significantly correlated with the severity of aortic valve regurgitation by trans thoracic echocardiography (p < 0.001). CONCLUSION: Although 64-MDCT accurately detects moderate and severe aortic regurgitation in patients referred to coronary CT angiography, mild aortic regurgitation can be missed on 64-MDCT in the presence of severe valve calcification or bicuspid valves.
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Feuchtner et al. (2008) conducted a cross-sectional in Aortic valve regurgitation (n=81). 64-MDCT coronary angiography vs. Transthoracic echocardiography was evaluated on Diagnostic accuracy for detecting aortic valve regurgitation (Sensitivity 73%, Specificity 97%). 64-MDCT coronary angiography demonstrated 73% sensitivity and 97% specificity for detecting aortic regurgitation, with sensitivity improving to 95% for moderate and severe cases.