Diagnostic value of multidetector computed tomography in evaluating mechanical prosthetic valve complications at Hanoi Heart Hospital

Q: What are the key findings of this study?

Cardiac MDCT detected overall mechanical prosthetic valve complications with 82.8% sensitivity, 84.6% specificity, and 83.3% accuracy, achieving 97.6% accuracy for both thrombus and pannus.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Suspected mechanical aortic and/or mitral prosthetic valve complications (n=39). Intervention: Cardiac multidetector computed tomography (MDCT) vs. Surgical/histopathological findings in operated patients (n=18) or a composite clinical reference standard in non-operated patients (n=21). Primary outcome: Diagnostic accuracy for overall mechanical prosthetic valve complications (Acc 83.3% (Se 82.8%, Sp 84.6%, PPV 92.3%, NPV 68.8%), 95% CI 69.4-91.7).

Q: What does this research mean for the field?

Cardiac multidetector computed tomography (MDCT) detects mechanical prosthetic valve complications with 83.3% accuracy and reliably differentiates thrombus from pannus based on attenuation and post-implantation timing. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Thúy Hồng Trần; Van Thinh Le

doi:10.47972/vjcts.vi.1947

November 9, 2026Tạp chí Phẫu thuật và Tim mạch và Lồng ngực Việt NamOpen Access

Diagnostic value of multidetector computed tomography in evaluating mechanical prosthetic valve complications at Hanoi Heart Hospital

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Key result

Cardiac MDCT detects mechanical prosthetic valve complications with ~83% overall diagnostic accuracy.

Acc 83.3% (Se 82.8%, Sp 84.6%, PPV 92.3%, NPV 68.8%)
95% CI 69.4-91.7
n=39

Why the study?

This study aimed to evaluate the diagnostic performance of multidetector computed tomography (MDCT) in detecting complications of mechanical aortic and mitral prosthetic valves.

What is the diagnostic accuracy of cardiac multidetector computed tomography (MDCT) compared with surgical or composite clinical reference standards in detecting complications in patients with suspected mechanical aortic and/or mitral prosthetic valve dysfunction?

Key Points

To evaluate the diagnostic performance of multidetector computed tomography (MDCT) in detecting complications associated with mechanical aortic and mitral prosthetic valves.
Retrospective cross-sectional diagnostic accuracy study of 39 patients with 42 mechanical aortic and/or mitral prosthetic valves who underwent cardiac MDCT for suspected complications at Hanoi Heart Hospital.
MDCT findings were validated against surgical findings in 18 operated patients or a composite clinical reference standard in 21 non-operated patients.
Sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, and inter-reader agreement (Cohen's kappa) were assessed.
For overall prosthetic valve complications, MDCT showed sensitivity of 82.8%, specificity of 84.6%, PPV of 92.3%, NPV of 68.8%, and accuracy of 83.3%.
Diagnostic indices reached 100% across all metrics for leaflet obstruction; for thrombus, sensitivity was 100%, specificity was 96.9%, and accuracy was 97.6%; for pannus, sensitivity was 92.9%, specificity was 100%, and accuracy was 97.6%.
All isolated thrombi showed CT attenuation <90 HU, whereas 91.7% of isolated pannus lesions had attenuation >145 HU (p<0.001); inter-reader agreement was 85.7% (Cohen's kappa = 0.71, 95% CI: 0.50–0.92).

Study Design

Type

Cross-Sectional (n=39)

Blinding

Two independent radiologists blinded to the final diagnosis

Multicenter

No

Structured PICO

What is the diagnostic accuracy of cardiac multidetector computed tomography (MDCT) compared with surgical or composite clinical reference standards in detecting complications in patients with suspected mechanical aortic and/or mitral prosthetic valve dysfunction?

P

Population

39 patients (mean age 57.0 years, 56.4% female) with 42 mechanical aortic and/or mitral prosthetic valves and suspected valve complications evaluated via cardiac MDCT at a single center in Vietnam.

I

Intervention

Electrocardiogram-gated cardiac multidetector computed tomography (MDCT) using 120-140 kVp, 0.625 mm slice thickness, and non-ionic iodinated contrast (300 mgI/mL at 1-1.5 mL/kg).

C

Comparator

Surgical/histopathological findings in operated patients (n=18) or a composite clinical reference standard (clinical, echocardiographic/TEE, microbiological, and treatment response data) in non-operated patients (n=21).

O

Outcome

Diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of MDCT for detecting overall mechanical prosthetic valve complications and specific complications (leaflet obstruction, thrombus, pannus, perivalvular abscess, prosthetic valve endocarditis) at the valve level (n=42).surrogate

Main Result

Effect estimate: Acc 83.3% (Se 82.8%, Sp 84.6%, PPV 92.3%, NPV 68.8%) (95% CI 69.4-91.7)

Cardiac MDCT demonstrates high diagnostic accuracy for evaluating suspected mechanical prosthetic valve complications, particularly in detecting leaflet obstruction and differentiating thrombus from pannus as a complementary modality to echocardiography.

Limitations

Small sample size (39 patients, 42 valves), resulting in wide confidence intervals
Retrospective design with differential verification bias between operated and non-operated patients
Potential incorporation bias in the composite clinical reference standard for non-operated patients
Selection/spectrum bias as only patients with suspected complications referred for MDCT were included
Potential intra-cluster correlation from patients with two mechanical valves without statistical adjustment for clustering
Limited number of patients (n=9) with comparative transesophageal echocardiography (TEE) data and lack of paired accuracy comparisons
Inter-reader reproducibility for quantitative HU attenuation measurements was not separately evaluated using intraclass correlation coefficients (ICC)
Small sample size (39 patients, 42 valves) leading to wide 95% confidence intervals
Retrospective single-center design with differential verification bias between operated and non-operated groups
Risk of incorporation bias in the composite clinical reference standard for non-operated patients
Selection/spectrum bias due to inclusion of only patients with suspected complications referred for MDCT
Lack of clustering adjustment for patients with two prosthetic valves
Limited paired comparative data with transesophageal echocardiography (n=9) and no ICC assessment for HU measurement reproducibility

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports MDCT as complementary imaging for suspected mechanical valve complications; extends prior data but leaves open need for prospective validation.

Abstract

Objective: To evaluate the diagnostic performance of multidetector computed tomography (MDCT) in detecting complications of mechanical aortic and mitral prosthetic valves. Methods: A diagnostic accuracy study with a retrospective cross-sectional design was conducted in 39 patients with 42 mechanical aortic and/or mitral prosthetic valves who underwent cardiac MDCT at Hanoi Heart Hospital because of suspected prosthetic valve complications. MDCT findings were compared with surgical findings in operated patients or an appropriate composite clinical reference standard in non-operated patients. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Acc) were calculated. Inter-reader agreement for MDCT diagnosis was assessed using Cohen’s kappa. Results: For overall mechanical prosthetic valve complications, MDCT showed Se of 82.8%, Sp of 84.6%, PPV of 92.3%, NPV of 68.8%, and Acc of 83.3%. For leaflet obstruction, all diagnostic indices were 100%. For thrombus, Se and Sp were 100% and 96.9%, respectively; for pannus, they were 92.9% and 100%, respectively; Acc was 97.6% for both. In an exploratory analysis with etiologic groups defined by the reference standard, all isolated thrombi had attenuation <90 HU, whereas 91.7% of isolated pannus lesions had attenuation >145 HU (p<0.001). Thrombus tended to occur earlier after surgery, whereas 91.7% of isolated pannus cases occurred more than 5 years after valve replacement (p<0.001). Among nine patients with comparative data, transesophageal echocardiography identified an etiology in 66.7%, whereas MDCT provided an etiologic classification in all cases; one MDCT classification was discordant with the reference standard. The two MDCT readers agreed in 85.7% of cases, with Cohen’s kappa = 0.71 (95% CI: 0.50–0.92). Conclusion: In this selected cohort with suspected mechanical prosthetic valve complications, MDCT showed promising diagnostic performance and provided complementary information on leaflet motion and the differentiation of thrombus from pannus. CT attenuation and time since valve replacement may support etiologic assessment but should be interpreted together with morphology and clinical findings. MDCT is a useful complementary modality to echocardiography in a multimodality diagnostic approach

Discussion

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Cite This Study

Trần et al. (2026) conducted a cross-sectional in Suspected mechanical aortic and/or mitral prosthetic valve complications (n=39). Cardiac multidetector computed tomography (MDCT) vs. Surgical/histopathological findings in operated patients (n=18) or a composite clinical reference standard in non-operated patients (n=21) was evaluated on Diagnostic accuracy for overall mechanical prosthetic valve complications (Acc 83.3% (Se 82.8%, Sp 84.6%, PPV 92.3%, NPV 68.8%), 95% CI 69.4-91.7). Cardiac MDCT detected overall mechanical prosthetic valve complications with 82.8% sensitivity, 84.6% specificity, and 83.3% accuracy, achieving 97.6% accuracy for both thrombus and pannus.

synapsesocial.com/papers/6af1d893f9a8addd138b1c90 https://doi.org/10.47972/vjcts.vi.1947

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Diagnostic value of multidetector computed tomography in evaluating mechanical prosthetic valve complications at Hanoi Heart Hospital

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Diagnostic value of multidetector computed tomography in evaluating mechanical prosthetic valve complications at Hanoi Heart Hospital

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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