Kongkiat Chaikriangkrai, MD, third-year fellow in Cardiovascular Disease, is first author on a new systematic review and meta-analysis in the Journal of Thoracic Imaging comparing the accuracy of coronary CT performed on patients about to undergo surgical and transcatheter aortic valve replacement (TAVR). Dr. Chaikriangkrai and his co-authors, many of whom are also fellows in the Cardiovascular Disease program here, evaluated thirteen different studies, which each compared how well coronary CT and invasive coronary angiography identify the presence of coronary artery disease (CAD).

TAVR is a relatively recent procedure often recommended for patients with aortic stenosis—a narrowing of the valve leading to a variety of other complications—but who are not healthy enough for open heart surgery. Invasive coronary angiography is the exam currently recommended to evaluate any associated CAD, but it is an invasive test and usually more expensive than coronary CT, which is already a part of pre-procedural evaluation for TAVR.

But can coronary CT identify CAD as well as invasive coronary angiography? This was the question driving the review performed by Dr. Chaikriangkrai and his co-authors. What they found is that, across thirteen studies and nearly 1,500 patients, cardiac CT resulted in enough accurate diagnoses to give the exam, as the authors put it, “suitable diagnostic accuracy as a gatekeeper test,” but not enough to suggest its replacement of invasive coronary angiography. Dr. Chaikriangkrai says, “We need more dedicated research in this management approach that incorporates cardiac CT.”

Dr. Chaikriangkrai’s co-authors from the University of Iowa include Drs. Ghanshyam Palamaner Subash Shantha, Aref Bin Abdulhak, Rudhir Tandon, Musab Alqasrawi, Anthony Klappa, and Jay Bhama.