You are here

Article Text

Article menu

Download PDFPDF

Cardiac surgery
Original research
Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score
  1. Rasmus Bo Hasselbalch1,2,
  2. Mia Marie Pries-Heje1,
  3. Sarah Louise Kjølhede Holle1,
  4. Thomas Engstrøm3,
  5. Merete Heitmann4,
  6. Frants Pedersen3,
  7. Morten Schou1,5,
  8. Hans Mickley6,
  9. Hanne Elming7,
  10. Rolf Steffensen8,
  11. Lars Koeber3 and
  12. Kasper Iversen1,2
  1. 1Department of Cardiology, Herlev Hospital, Herlev, Denmark
  2. 2Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
  3. 3Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  4. 4Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
  5. 5Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  6. 6Department of Cardiology, Odense University Hospital, Odense, Denmark
  7. 7Department of Cardiology, Roskilde Hospital, Roskilde, Sjaelland, Denmark
  8. 8Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
  1. Correspondence to Dr Rasmus Bo Hasselbalch; rasmus.bo.hasselbalch{at}regionh.dk

Abstract

Objective To prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).

Methods This was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.

Results In total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.

Conclusion The CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

  • coronary artery disease
  • risk stratification
  • valvular disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001380

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors The study was designed by RBH and KI. Data collection was handled by RBH, SH, MP-H, TE, MH, FP, MS, HM, HE, RS and LK. KI and RBH did the data analyses. RBH and KI wrote the first manuscript. All authors critically revised the manuscript and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study complied with the Declaration of Helsinki II. The project was approved by the Danish Data Protection Agency (2014-41-3261) and The Danish Medicines Authority (3-3013-987/1), who determined no patient consent was necessary under Danish law.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request to the corresponding author (RBH).