Echocardiography and computed tomography angiography for diagnosing coronary artery fistula in adults: imaging features and diagnostic efficacy

Abstract

Objective To analyze the imaging characteristics and diagnostic value of echocardiography and computed tomography angiography (CTA) in coronary artery fistula in adults. Methods Thirty patients with suspected coronary artery fistula admitted to Changzheng Hospital Affiliated to Naval Medical University from January 2011 to December 2018 were retrospectively selected. All patients underwent transthoracic echocardiography and CTA, and were eventually diagnosed by surgery or coronary angiography. Twenty-three patients with coronary artery fistula and seven patients with non-coronary artery fistula were diagnosed based on surgical exploration or coronary angiography. The efficacy of echocardiography and CTA in the diagnosis of coronary artery fistula was analyzed and compared. Results Of the 23 patients with coronary artery fistula, 20 were accurately diagnosed by echocardiography and 3 had a misdiagnosis, of whom 2 were misdiagnosed as having left coronary artery-pulmonary artery fistula, and 1 was misdiagnosed as having right coronary artery-right ventricular fistula. Of the 23 patients with coronary artery fistula, 22 were accurately diagnosed by coronary CTA, and 1 was misdiagnosed with left coronary artery-pulmonary artery fistula. Taking surgical results or coronary angiography as the standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of echocardiography for diagnosing coronary artery fistula were 86.96%, 71.43%, 90.90%, 62.50%, and 83.33%, respectively; the corresponding percentages of coronary CTA were 95.65%, 85.71%, 95.65%, 85.71%, and 93.33%, respectively. Both methods had a good consistency with the gold standard (κ1=0.757, P<0.001; κ2=0.911, P<0.001). Conclusion Both echocardiography and CTA are of good value for the diagnosis of coronary artery fistula, and can provide effective and reliable information for the diagnosis of this disease. Key words: Echocardiography; Coronary artery fistula; Computed tomography angiography