Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: comparison of accuracy, radiation dose and cost versus invasive coronary angiography.
BACKGROUND
The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT.


METHODS
Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost.


RESULTS
The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B.


CONCLUSIONS
The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.
['Pontone|Gianluca|G|', 'Andreini|Daniele|D|', 'Bertella|Erika|E|', 'Cortinovis|Sarah|S|', 'Mushtaq|Saima|S|', 'Foti|Claudia|C|', 'Annoni|Andrea|A|', 'Formenti|Alberto|A|', 'Baggiano|Andrea|A|', 'Conte|Edoardo|E|', 'Ballerini|Giovanni|G|', 'Fiorentini|Cesare|C|', 'Bartorelli|Antonio L|AL|', 'Pepi|Mauro|M|']
D000368:Aged D000369:Aged, 80 and over D017023:Coronary Angiography D003365:Costs and Cost Analysis D005260:Female D006801:Humans D008297:Male D008945:Mitral Valve Prolapse D061330:Multidetector Computed Tomography D011300:Preoperative Care D011829:Radiation Dosage D012017:Referral and Consultation
Mitral valve prolapse Mitral valve prolapse Accuracy Invasive coronary angiography Invasive coronary angiography multidetector computed tomography coronary angiography MDCT ICA CAD MVP effective radiation dose ED CI Coronary artery disease Cost-Effectiveness EF HR LVEDV LVESV NPV PAP PPV Se Sp TTE USD United States Dollar confidence interval coronary artery disease ejection fraction heart rate invasive coronary angiography left ventricle end diastolic volume left ventricle end systolic volume mitral valve prolapse negative predictive value positive predictive value pulmonary artery pressure sensitivity specificity transthoracic echocardiography