Diagnostic value of the 16-detector row multislice spiral computed tomography for the detection of coronary artery stenosis in comparison to invasive coronary angiography

OBJECTIVES: The aim of this study was to determine the diagnostic accuracy of 16-slice multislice spiral computed tomography (MSCT) of the coronaries and to provide data in a real clinical setting. Previous 16-slice MSCT studies presented data excluding patients with calcification, vessels of < 1.5 or 2 mm, and segments with impaired image quality. By including these data for 16-slice MSCT, a direct comparison with new data from 64-slice MSCT is possible. METHODS AND RESULTS: Sixty two patients with suspected or known coronary artery disease (CAD) were prospectively enrolled and underwent computed tomography angiography (CTA) and invasive coronary angiography (ICA). All vessels were evaluated for the presence of a significant coronary artery stenosis (>50%) using the American Heart Association (AHA) 15-segment model. From the evaluation of 917 segments, sensitivity, specificity, and positive and negative predictive value (NPV) (positive predictive value [PPV] and NPV) for the presence of relevant coronary stenosis were 73, 98, and 71 and 98% per segment and 94, 90, and 91 and 93% per patient, respectively. The influence of age, gender, body surface area (BSA), heart rate (HR), stents, and Ca(2+)-score value was analyzed. High Ca(2+)-score values were the only statistically significant predictor for impaired diagnostic accuracy. CONCLUSIONS: In summary, CTA with evaluation of all vessel segments in a broad spectrum of patients allowed accurate and fast noninvasive coronary artery evaluation, including evaluation of stented segments. These data are very similar to those published recently for 64-slice scanners.     

Impact of coronary calcium score on diagnostic accuracy of multislice computed tomography coronary angiography for detection of coronary artery disease.

BACKGROUND: The impact of the coronary calcium score on the diagnostic accuracy of multislice computed tomography (MSCT) to detect obstructive coronary stenoses remains controversial. METHODS AND RESULTS: We examined 41 patients (mean Agatston score, 340 +/- 530 [range, 0-2546]) with coronary artery disease with 16-slice MSCT and 60 patients (mean Agatston score, 446 +/- 877 [range, 0-6264]) with 64-slice MSCT. MSCT scans were analyzed with invasive coronary angiography (CA) as the standard of reference. Lesions with luminal narrowing of 50% or greater were considered obstructive. In total, 9% and 2% of uninterpretable segments were excluded from analysis in patients examined with 16- and 64-slice MSCT, respectively. On a segment basis, the percentage of false-negative segments in the groups with Agatston scores of 0 to 100, 101 to 400, and greater than 400 with 16-slice MSCT were 0%, 5.3%, and 2.9% (P = .0005), respectively; other comparisons of false-positive and false-negative segments were not significant. The sensitivity and specificity on a vessel and patient basis with 16- and 64-slice MSCT were not significantly different in different calcium score groups. CONCLUSIONS: A slight impact of coronary calcium was observed on the diagnostic accuracy of 16-slice MSCT CA on a segment basis, with no significant impact on a vessel and patient basis. No significant impact of coronary calcium was observed on the diagnostic accuracy of 64-slice MSCT CA on a segment, vessel, or patient basis.     

Non-invasive evaluation of coronary artery bypass grafts using 16-row multi-slice computed tomography with 188 ms temporal resolution

BACKGROUND: Cardiac multi-slice computed tomography (MSCT) scanners permit visualization of the coronary arteries and coronary artery bypass grafts. The latest MSCT generation with true 16-detector slices (Sensation 16 Speed 4 D, Siemens, Forchheim, Germany) provides improved temporal and spatial resolution, as well as significantly reduced scan time. To assess, whether this technical improvement has also an impact on image quality and accuracy of MSCT diagnosis in patients with previous coronary artery bypass graft (CABG) surgery the following study was conducted. METHODS AND MATERIAL: Thirteen consecutive patients (pts) (10 male, 3 female, mean age 62 +/- 6.4 [55-73] years, heart rate 68 +/- 11 [52-88] bpm) and a total number of 43 coronary bypass grafts (11 arterial, 32 venous grafts) were examined by MSCT (gantry rotation time 375 ms). In addition to the analysis of coronary bypass grafts, 13 coronary segments (sgts) were evaluated in each patient (n = 169 sgts). MSCT results were compared with coronary angiography. RESULTS: Forty-one of 43 bypass grafts (95%) were analyzable by MSCT. In conventional angiography 16 of 43 (37%) grafts were occluded. Sixteen of them were correctly diagnosed by MSCT (sensitivity 100%). One graft showed a 50% anastomosis stenosis which was also detected. Twenty-five of 27 grafts without severe lesion showed no significant stenosis in MSCT (specificity 93%, positive predictive value (PPV) 89%, negative predictive value (NPV) 100%). Ninety of 108 (83%) high-grade stenosis (>70%) of the native coronary vessels were correctly detected (sensitivity 83%, PPV 78%). From the 61 sgts without high grade stenosis 36 were correctly classified (specificity 59%, NPV 67%). If sgts number 8, 9 and 10, which are normally not target for revascularization, are excluded sensitivity rises to 89%, specificity to 71%, PPV to 87% and NPV to 75%. The correct clinical diagnosis (absence or presence of a high grade stenosis of at least one bypass graft) was achieved in all patients. CONCLUSIONS: True 16-slice MSCT with faster gantry rotation time allows detection of lesions in coronary artery bypass grafts with high sensitivity and specificity. The evaluation of native vessels in pts with known CAD remains a diagnostic challenge. However, the correct clinical diagnosis was achieved in all pts. MSCT is a non-invasive tool to assess coronary artery bypass grafts.     

Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis.

OBJECTIVES: This study was designed to define the current role of multislice spiral computed tomography (MSCT) for the diagnosis of coronary artery disease (CAD) using a meta-analytic process. BACKGROUND: Multislice spiral computed tomography has recently been proposed as an alternative to conventional coronary angiography (CA) for the diagnosis of CAD. METHODS: Using Medline, we identified 29 studies (2,024 patients) evaluating CAD by means of both MSCT (> or =16 slices) and conventional CA before July 2006. After data extraction the analysis was performed according to a random-effects model. RESULTS: The per-segment analysis pooled the results from 27 studies corresponding to a cumulative number of 22,798 segments. Among unassessable segments, 4.2% were excluded from the analysis and 6.4% were classified at the discretion of the investigators, underscoring the shortcomings of MSCT. With this major limitation, the per-segment sensitivity and specificity were 81% (95% confidence interval [CI] 72% to 89%) and 93% (95% CI 90% to 97%), respectively, with positive and negative likelihood ratios of 21.5 (95% CI 13.1 to 35.5) and 0.11 (95% CI 0.06 to 0.21), respectively, and positive and negative predictive values of 67.8% (95% CI 57.6% to 78.0%) and 96.5% (95% CI 94.7% to 98.3%), respectively. As expected, the per-patient analysis has shown an increased sensitivity of 96% (95% CI 94% to 98%) but a decreased specificity of 74% (95% CI 65% to 84%). CONCLUSIONS: Multislice spiral computed tomography has shortcomings difficult to overcome in daily practice and, at the more clinically relevant per-patient analysis, continues to have moderate specificity in patients with high prevalence of CAD. Studies evaluating the diagnostic performance of the newest generation of MSCT, including patients with low to moderate CAD prevalence, will be critical in establishing the clinical role of this emerging technology as an alternative to CA.     

Diagnostic accuracy of computed tomography coronary angiography in routine practice

OBJECTIVES: The recent newer advances in computed tomography have dramatically changed our approach to imaging cardiac disease. This study sought to compare the diagnostic value of 16-multi-detector spiral computed tomography (MSCT) for detecting coronary artery stenosis. METHODS: A total of 88 consecutive patients (52 men, mean age 68 +/- 8 years) with atypical chest pain, stable angina or suspicion of ischaemia at stress test were studied by MSCT and invasive coronary angiography (ICA). The MSCT images and multiplanar reconstructions were analysed regarding the presence of > or =50% coronary artery lesion. RESULTS: All 88 scans obtained at a mean heart rate of 68 +/- 8 beats/min were interpretable. Sixteen coronary segments were evaluated in each patient. Of the 1320 segments examined, 148 (11%) showed poor image quality.A total of 150 significant lesions were detected using ICA, and 80 of 150 (53%) were detected by MSCT. Sensitivity, specificity, positive and negative predictive values were as follows: 53%, 97%, 68%, and 94%. Fifty-four patients had > or =50% coronary stenosis.The diagnosis was confirmed by MSCT in 42 patients and correctly ruled out in 30. By patient-based analysis, positive and negative predictive values were 91% and 71%. CONCLUSION: Although its specificity is high, the sensitivity of 16-slice MSCT for detecting > or =50% coronary stenosis in non-selected patients submitted to ICA is rather low suggesting that for daily practice the diagnostic value of this technique should be improved.     

Head-to-head comparison of multislice computed tomography and exercise electrocardiography for diagnosis of coronary artery disease.

AIMS: To prospectively compare multislice computed tomography (MSCT) and exercise electrocardiography (ex-ECG) for diagnosis of coronary artery disease (CAD) with conventional coronary angiography as the reference standard. METHODS AND RESULTS: A consecutive cohort of 80 patients with suspected CAD was examined with MSCT using 16 x 0.5 mm detector collimation, ex-ECG, and conventional coronary angiography according to standard protocols. Results were compared using the paired McNemar's test, the chi(2) test, and 95%CIs. Both the sensitivity and specificity of MSCT [91% (40 of 44 patients, 95%CI 78-97%) and 83% (30 of 36 patients, 95%CI 67-94%)] were significantly higher (P = 0.039 and P < 0.001) than those for ex-ECG [73% (32 of 44 patients, 95%CI 57-85%) and 31% (11 of 36 patients, 95%CI 16-48%)]. The pairwise McNemar's test showed significant differences between MSCT and ex-ECG in the overall diagnosis in patients with suspected CAD (P = 0.036). The rate of non-diagnostic examinations was not significantly (P = 0.078) different between MSCT and ex-ECG [8% (6 of 80 patients, 95%CI 3-16%) vs. 19% (15 of 80 patients, 95%CI 11-29%)]. CONCLUSION: In this consecutive cohort of patients scheduled to undergo conventional coronary angiography, the performance of MSCT for diagnosis of CAD was superior to that of ex-ECG.     

Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial.

BACKGROUND: Non-invasive coronary angiography by multislice spiral computed tomography (MSCT) is a promising method for the diagnosis of coronary artery disease (CAD). However, the clinical role of this method has not been established for specific patient cohorts. Therefore, the objective of the current prospective, blinded study was to investigate the diagnostic value of coronary MSCT angiography in patients with an intermediate pre-test probability for having CAD when compared with invasive angiography. METHODS AND RESULTS: A total of 243 patients with an intermediate pre-test probability for having CAD were asked to undergo coronary 16- or 64-slice CT angiography before planned invasive angiography from 12 September 2003 to 13 July 2005. The primary end point was defined as the diagnostic accuracy in the detection of significant coronary stenosis (> or =50% lumen diameter reduction) on a per-patient and an 'intention-to-diagnose'-based analysis. Secondary end points comprised per-artery and per segment-based analyses as well as the comparison of diagnostic accuracy of 16- vs. 64-slice MSCT angiography. Of 243 enrolled patients, 129 and 114 patients were studied by 16- and 64-slice CT angiography, respectively. The overall sensitivity, negative predictive value, and specificity for CAD detection by MSCT were 99% (95% CI, 94-99%), 99% (95% CI, 94-99%), and 75% (95% CI, 67-82%), respectively. On a per-segment basis, the use of 64-slice CT was associated with significantly less inconclusive segments (7.4 vs. 11.3%, P < 0.01), resulting in a trend to an improved specificity (92 vs. 88%, P = 0.09). CONCLUSION: In patients with an intermediate pre-test probability for having CAD this large, prospective trial demonstrates that non-invasive coronary CT angiography is a very sensitive method for CAD detection. Furthermore, this method allows ruling out CAD very reliably and safely. Finally, 64-slice CT appears to be superior for CAD detection when compared with 16-slice CT.     

64层螺旋CT血管成像与冠状动脉造影对冠心病诊断价值的对比研究

目的评价64层螺旋CT在冠状动脉造影方面的诊断价值。方法58例临床诊断或可疑冠心病患者行64层螺旋CT冠状动脉成像检查,分别对左主干、左前降支、回旋支和右冠状动脉及其分支的重建图像行影像学评价,所有患者均行常规选择性冠状动脉造影检查作为对照。结果58例患者共757(87.0%)节段的冠状动脉(血管直径≥1.5 mm)成像,638节段(84.3%)可用于多层螺旋CT和冠状动脉造影定量分析。冠状动脉造影共发现狭窄101节段,多层螺旋CT发现狭窄104节段,多层螺旋CT对冠状动脉狭窄诊断的敏感性为86.1%,特异性为96.8%。结论64层螺旋CT冠状动脉造影可作为诊断冠状动脉病变的一种无创筛选方法。     

Do risk factors influence the diagnostic accuracy of noninvasive coronary angiography with multislice computed tomography?

BACKGROUND: Multislice computed tomography (MSCT) is a relatively new noninvasive imaging modality in the evaluation of patients with suspected coronary artery disease (CAD). Whether diagnostic accuracy is influenced by gender or risk factors for CAD is currently unknown and was evaluated in this study. METHODS AND RESULTS: In 197 patients (171 men and 26 women; mean age, 60 +/- 11 years) 16-slice MSCT was performed and compared with invasive coronary angiography at 2 different centers (Leiden and Rotterdam, The Netherlands). Diagnostic accuracy for the detection of 50% luminal narrowing or greater was calculated for all patients combined, as well as for patients with known versus suspected CAD. In addition, diagnostic accuracy was determined in men versus women and in different subsets of patients based on the presence of risk factors for CAD including hypertension, type 2 diabetes mellitus, hypercholesterolemia, and obesity. Only segments with a diameter of 2.0 mm or greater were evaluated, whereas smaller segments and stents were excluded from the analysis. Overall, a sensitivity and specificity of 99% and 86%, respectively, on a patient level were demonstrated, with corresponding positive and negative predictive values of 95% and 96%, respectively. Similar values were observed in the different subsets of patients, with no statistical differences. CONCLUSION: These findings confirm the high diagnostic accuracy of MSCT, regardless of gender or risk factors.     

Accuracy of 64-slice computed tomography for the preoperative detection of coronary artery disease in patients with chronic aortic regurgitation

We studied the diagnostic accuracy of 64-slice computed tomography for the diagnosis of significant coronary artery disease (CAD) compared with conventional coronary angiography (CA) in patients with chronic aortic regurgitation (AR) referred for elective aortic valve surgery. Fifty consecutive patients with chronic AR (38 men, mean age 54 +/- 14 years) scheduled for valve surgery underwent 64-slice computed tomographic (CT) coronary angiography and CA. Significant stenosis was defined as a luminal diameter decrease >50%. Mean heart rate during CT scanning was 65.5 +/- 7.4 beats/min. Mean Agatston score was 136 +/- 278 (range 0 to 1207); prevalence of significant CAD in the study population was 26% (13 of 50 patients). Thirteen of 742 segments (1.8%) in 3 patients were considered nondiagnostic with computed tomography because of motion artifacts (n = 9) or calcium (n = 4). In a patient-based analysis taking nonevaluative segments as falsely positive, sensitivity, specificity, and positive and negative predictive values of computed tomography were 100%, 95%, 87%, and 100%, respectively. Preoperative CA could have been avoided in 70% of patients (35 of 50), CA would have been performed to confirm the CT diagnosis in 26% (13 of 50), and unnecessary CA would have been performed in 4% (2 of 50) on the basis of false-positive CT ratings. In conclusion, 64-slice CT coronary angiography provides high diagnostic accuracy for diagnosing significant CAD in patients with chronic AR and may be used as a filter test before valve surgery to decide whether CA should be performed.     

Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results

OBJECTIVES: The aim of our study was to evaluate the feasibility of detecting coronary artery lesions using a new computed tomography (CT) scanner with 16 detectors and faster gantry rotation. BACKGROUND: Computed tomography angiography of the coronaries permits assessment of the coronaries; however, image quality is still impaired by motion artifacts and calcifications. METHODS: Sixty patients scheduled for conventional coronary angiography (CCA) were additionally studied by multislice spiral computed tomography (MSCT).Calcium scores and a contrast-enhanced visualization of the coronaries were performed and analyzed regarding evaluability, presence of coronary artery lesions, and correct clinical diagnosis. RESULTS: Calcium scoring was successful in all patients; 58 of 60 patients had a diagnostic contrast-enhanced scan. Mean calcium score was 506 +/- 743 Agatston score equivalent (ASE); 13 of 58 (22%) patients had an ASE >or=1,000, 46 of 58 (78%) patients <1,000. In 763 coronary segments, CCA detected a total of 75 lesions >or=50%. The MSCT correctly assessed 54 of these. Twenty-one lesions were missed or incorrectly underestimated. Sensitivity was 72%, specificity 97%. When restricting analysis to patients with an ASE <1,000, 40 significant lesions >or=50% were seen on CCA, and MSCT correctly detected 39 lesions (sensitivity 98%, specificity 98%). Regardless of any threshold, the correct clinical diagnosis could be obtained in 58 of 60 (97%) of all patients. CONCLUSIONS: In individuals with low-to-moderate amounts of coronary artery calcium, 16-detector CT coronary angiography has high sensitivity and specificity for the diagnosis of significant coronary artery stenosis.     

Diagnostic performance of 64-slice computed tomography coronary angiography to detect significant coronary artery stenosis

OBJECTIVE: We aimed to determine the diagnostic accuracy of 64-slice multi-slice computed tomography (MSCT) to detect significant coronary artery stenosis with comparison to conventional coronary angiography (CCA). METHODS: In 100 patients (70 men, average age 58 +/- 10 years and age range 31-75 years) scheduled to have conventional coronary angiography, MSCT was performed before catheterization (within 2 months). All patients were in sinus rhythm, able to hold breath for 15 seconds, and had serum creatinine levels < 1.5 mg/dl. MSCT scans were analysed by a radiologist and a cardiologist. Sensitivity, specificity, positive and negative predictive values for the detection of significant stenoses by MSCT in comparison with CCA were calculated on patient, vessel, and segmental bases. RESULTS: 64-slice computed tomography is able to detect significant coronary artery stenosis on a segmental basis with a sensitivity of 88% and specificity of 99% when compared with CCA. All patients with significantly stenotic coronary artery disease are correctly diagnosed. The presence of significant stenosis was correctly diagnosed by MSCT in 126 of 144 segments. Twelve non-significant lesions on CCA were overestimated by MSCT. On vessel-based analysis, the sensitivity and specificity of MSCT for detecting significant stenosis were 91% and 97%, respectively. CONCLUSION: Our results indicate that 64-slice computed coronary angiography is a reliable diagnostic modality for the detection of significant coronary artery stenosis in patients with sinus rhythm and scheduled to have CCA, but still has limitations of diagnostic performance on a per-segment and per-vessel basis.     

Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease.

OBJECTIVES: This study sought to determine the prognostic value of multislice computed tomography (MSCT) coronary angiography in patients with known or suspected coronary artery disease (CAD). BACKGROUND: It is expected that MSCT will be used increasingly as an alternative imaging modality in the diagnosis of patients with suspected CAD. Data on the prognostic value of MSCT, however, are currently not available. METHODS: A total of 100 patients (73 men, age 59 +/- 12 years) who were referred for further cardiac evaluation due to suspicion of significant CAD underwent additional MSCT coronary angiography to evaluate the presence and severity of CAD. Patients were followed up for the occurrence of: 1) cardiac death, 2) nonfatal myocardial infarction, 3) unstable angina requiring hospitalization, and 4) revascularization. RESULTS: Coronary plaques were detected in 80 (80%) patients. During a mean follow-up of 16 months, 33 events occurred in 26 patients. In patients with normal coronary arteries on MSCT, the first-year event rate was 0% versus 30% in patients with any evidence of CAD on MSCT. The observed event rate was highest in the presence of obstructive lesions (63%) and when obstructive lesions were located in the left main (LM)/left anterior descending (LAD) coronary arteries (77%). Nonetheless, an elevated event rate was also observed in patients with nonobstructive CAD (8%). In multivariate analysis, significant predictors of events were the presence of CAD, obstructive CAD, obstructive CAD in LM/LAD, number of segments with plaques, number of segments with obstructive plaques, and number of segments with mixed plaques. CONCLUSIONS: Multislice computed tomography coronary angiography provides independent prognostic information over baseline clinical risk factors in patients with known and suspected CAD. An excellent prognosis was noted in patients with a normal MSCT.     

64排螺旋CT冠状动脉成像在冠状动脉病变诊断中的临床研究

目的探讨和评价64排螺旋CT（MSCT）在冠心病诊断中的有效性。方法选取在3周内行64排MSCT和冠状动脉造影（CAG）检查的临床可疑或确诊冠心病的患者（两项检查平均间隔时间9d）114例，其中男性62例，平均年龄65岁。将MSCT和CAG检查结果进行分析，管腔狭窄≥50％定义为明显狭窄。结果在114例患者中，CAG检出至少有1处明显狭窄的患者106例，其中单支病变占33％（38例），多支病变占60％（68例）。MSCT检出其中的104例（诊断准确度95％）。按节段分析，MSCT诊断冠状动脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为87％、96％、86％、96％。以各冠状动脉分析，MSCT诊断冠状动脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值分别为96％、94％、95％、96％。MSCT与CAG在发现冠状动脉明显狭窄上差异无统计学意义（P〉0．05）。结论64排MSCT诊断冠状动脉狭窄的准确度较高，作为一种冠心病诊断的无创筛查手段，有广泛的临床应用价值。     

Accuracy of thin-slice computed tomography in the detection of coronary stenoses.

AIM: Our aim was to investigate the accuracy of multislice spiral computed tomography (MSCT) in the detection of significant (>50%) coronary stenosis using a scanner equipped for 16 x 0.625 mm collimation. METHODS: In 64 patients (59 male, mean age 58 +/- 5 years) with suspected coronary artery disease, MSCT (GE Light Speed-16, collimation: 16 x 0.625 mm) was performed 20 +/- 5 days before coronary angiography (CAG). Only angiographic segments >1.5 mm were considered for analysis. RESULTS: In all patients, MSCT was carried out without complications. Three patients were excluded from the analysis. Of 729 angiographic segments, 613 (84%) were judged evaluable by MSCT. Considering only the segments judged evaluable, the sensitivity was 89%, specificity 98%, positive predictive value 90%, and negative predictive value 98%. Including all segments in the analysis (evaluable and nonevaluable), sensitivity was 78%. CONCLUSIONS: Using a scanner with a collimation of 16 x 0.625 mm, our study confirms the potential role of MSCT in the detection of significant coronary stenosis with a sensitivity of 89% and a very high specificity (98%). Exclusion criteria and less than full evaluability of the coronary arteries must still be considered limitations of the method.     

Usefulness of multislice computed tomography for detecting obstructive coronary artery disease

The latest generation of multislice spiral computed tomography (MSCT) scanners is capable of noninvasive coronary angiography. We evaluated its diagnostic accuracy to detect stenotic coronary artery disease (CAD). In 53 patients with suspected CAD, contrast-enhanced MSCT and conventional angiography were performed. The CT data were acquired within a single breathhold, and isocardiophasic slices were reconstructed by means of retrospective electrocardiographic gating. Coronary segments of > or = 2 mm in diameter, measured by quantitative angiography, were evaluated. In 70% of the 358 available segments, image quality was regarded as adequate for assessment. The overall sensitivity, specificity, and positive and negative predictive values to detect > or = 50% stenotic lesions in the assessable segments were 82% (42 of 51 lesions), 93% (285 of 307 nonstenotic segments), and 66% and 97%, respectively, regarding conventional quantitative angiography as the gold standard. Proximal segments were assessable in 92%, and distal segments and side branches in 71% and 50%, respectively. Including the undetected lesions in non-assessable segments, overall sensitivity decreased to 61% but remained 82% for lesions in proximal coronary segments. MSCT correctly predicted absent, single, or multiple lesions in 55% of patients. Thus, despite potentially high image quality, current MSCT protocols offer only reasonable diagnostic accuracy in an unselected patient group with a high prevalence of CAD.     

Diagnostic performance of 320-slice computed tomography coronary angiography for symptomatic patients in clinical practice

ObjectiveMulti-slice computed tomography (MSCT) coronary angiography has been reported as an effective alternative to invasive conventional coronary angiography (CCA) for the diagnosis of coronary artery disease (CAD). However, in previous reports, the diagnostic accuracy of MSCT has not been significant enough to be of benefit in symptomatic patients. The aim of this study was to identify the usefulness of 320-slice computed tomography coronary angiography (320-CTA) for symptomatic patients in terms of the diagnostic accuracy of 320-CTA and the prevalence of vasospastic angina pectoris (VSAP) within the study cohort.MethodsWe retrospectively analyzed 513 consecutive symptomatic patients with suspected CAD who had undergone 320-CTA and CCA. We determined the diagnostic accuracy of 320-CTA using CCA as the reference standard. Ergonovine provocation tests were performed on patients without significant coronary artery stenosis on CCA.ResultsOf the total cohort of 513 symptomatic patients, 39% had obstructive CAD. The patient based analysis of the accuracy of 320-CTA showed a sensitivity of 91.0%, a specificity of 71.0%, a positive predictive value of 66.5%, and a negative predictive value of 92.5%. Of the 314 symptomatic patients who did not have significant coronary artery stenosis on CCA, 58 (18%) were diagnosed with VSAP using ergonovine provocation tests.DiscussionThe negative and positive predictive values indicate that 320-CTA cannot replace CCA for symptomatic patients. Indeed, a combination of CCA and ergonovine provocation tests should be taken into consideration for symptomatic patients.     

Noninvasive coronary imaging and assessment of left ventricular function using 16-slice computed tomography

In recent years, multislice computed tomography (MSCT) has been demonstrated to be a feasible imaging modality for noninvasive coronary angiography and left ventricular function analysis. The present study evaluated overall performance of 16-slice MSCT in the detection of significant coronary artery disease, stent, or bypass graft stenosis in combination with global left ventricular function analysis. Forty-five patients underwent 16-slice MSCT. Multislice computed tomograms were used to evaluate the presence of significant coronary artery stenoses (>/=50% decrease in luminal diameter) in native coronary segments, bypass grafts, and coronary stents and were compared with conventional coronary angiograms. In addition, left ventricular ejection fraction was calculated and compared with 2-dimensional echocardiography. MSCT was performed successfully in all patients. A close correlation between MSCT and 2-dimensional echocardiography was demonstrated for the assessment of left ventricular ejection fraction (y = 0.93x +3.33, r = 0.96, p <0.001). A total of 298 of native coronary artery segments (94%) were evaluated with MSCT, whereas 81 of 94 grafts (85%) and 41 of 52 coronary stents (79%) were also evaluated. For all segments, overall sensitivity, specificity, and positive and negative predictive values were 85%, 89%, 71%, and 95%, respectively. In conclusion, 16-slice MSCT is a feasible modality for noninvasive evaluation and exclusion of coronary artery disease in patients who present with chest pain.     

Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease

The purpose of the present study was to determine the diagnostic accuracy of current 64-slice multislice computed tomography (MSCT) in the detection of significant coronary artery disease, using conventional coronary angiography as the gold standard. In 61 patients scheduled for conventional coronary angiography, 64-slice MSCT was performed and evaluated for the presence of significant (>or=50% luminal narrowing) stenoses. One patient had to be excluded because of a heart rate>90 beats/min during data acquisition. In the remaining 60 patients (46 men, 14 women; average age 60+/-11 years), 854 segments were available for evaluation. Of these segments 842 (99%) were of sufficient image quality. Conventional coronary angiography identified 73 lesions, of which 62 were detected by MSCT. The corresponding sensitivity and specificity were 85% and 97%, respectively. On a patient-per-patient analysis, sensitivity, specificity, and positive and negative predictive values were 94%, 97%, 97%, and 93%, respectively. In conclusion, the present study confirms that 64-slice MSCT enables the accurate and noninvasive evaluation of significant coronary artery stenoses.     

Simultaneous dobutamine stress echocardiography and dobutamine scintigraphy (99mTc-MIBI-SPET) for assessment of coronary artery disease

Background: Simultaneous dobutamine stress echocardiography (DSE) and^99mTc-MIBI-SPET (DMS) for the evaluation of the presence and the extent of coronary artery disease (CAD) were assessed for a head to head comparison regarding the diagnostic accuracy of the two tests. Methods and Results: Forty-five consecutive patients (33 males and 12 females: 53±6.8 yr.) underwent exercise electrocardiography and simultaneous dobutamine stress echocardiography and MIBI-SPET imaging. Coronary angiography was performed in all patients (significant coronary stenosis > 50%). On the basis of the results of exercise electrocardiogram the pre-test probability for coronary artery disease (Diamond's algorithm) was low (45.6±12.7 %). The overall specificity, sensitivity and predictive accuracy of Echo-dobutamine stress test for diagnosis of the presence or absence of CAD were: specificity 82%, sensitivity 76%, diagnostic accuracy 80%, positive predictive value 90%, negative predictive value 40%. The overall specificity, sensitivity and predictive accuracy of MIBI-SPET-dobutamine test for diagnosis of the presence or absence of CAD were: specificity 86%, sensitivity 87%, diagnostic accuracy 84%, positive predictive value 97%, negative predictive value 54%. MIBI-SPET-dobutamine test showed a significantly higher sensitivity in comparison with ECHO-dobutamine test (P<0.05). Conclusion: Both noninvasive methods for the detection of CAD showed a good diagnostic accuracy. Nevertheless the SPET model showed an higher sensitivity in comparison with DSE model, essentially in the presence of a lower extent of CAD and during submaximal test.