Dual source computed tomography coronary angiography in new onset cardiomyopathy

AIM:To evaluate safety and utility of coronary computed tomography angiography(CCTA) compared to invasive coronary angiography(ICA) in new cardiomyopathy.METHODS:Eighteen patients(mean age 56.5 years,10 males) who presented for evaluation of new onset heart failure with evidence of systolic dysfunction(ejection fraction < 40%) on echocardiography and recent ICA were prospectively enrolled.Patients with known coronary artery disease,atrial fibrillation,creatinine > 1.5 g/dL,and contraindication to intravenous contrast administration were excluded.CCTA was performed using a dual source 64-slice scanner.Mean heart rate was 75 beats per minute.Stenosis was graded for each coronary segment as:none,mild(< 50%),moderate(50%-70%),severe(> 70%),or non-evaluable.Ischemic cardiomyopathy(ICM) was diagnosed if severe stenosis was present in the left main,proximal left anterior descending artery,or two or more major arteries.RESULTS:Two patients were diagnosed with ICM by ICA.CCTA correctly identified 2 patients with ICM and 16 patients as non-ICM.CCTA successfully evaluated 240/246 coronary segments with an accuracy of 97.5%,sensitivity 70%,specificity 98.7%,positive predictive value of 70%,and negative predictive value of 98.7% for identifying severe stenosis on a per-segment level.CONCLUSION:Dual source 64-slice multi-detector CCTA is a safe,accurate,and non-invasive technique for diagnosing ICM in patients presenting during the acute phase of newly diagnosed cardiomyopathy.