Objectives This study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD). ...Background CTCA is emerging as a noninvasive technique to detect coronary atherosclerosis. Methods We conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as ≥50% lumen diameter reduction. Results The prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval CI: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%). Conclusions Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.
64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease W. Bob Meijboom, Carlos A. G. van Mieghem, ...Nico R. Mollet, Francesca Pugliese, Annick C. Weustink, Niels van Pelt, Filippo Cademartiri, Koen Nieman, Eric Boersma, Peter de Jaegere, Gabriel P. Krestin, Pim J. de Feyter We assessed the usefulness of 64-slice computed tomography (CT) coronary angiography to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities. The estimated pretest probability of CAD in patients with high, intermediate, or low pretest probability was 87%, 53%, and 13%. The estimated post-test probability of a negative CT scan was 17%, 0%, and 0%, and of a positive CT scan was 96%, 88%, and 68%. Computed tomography coronary angiography is useful in symptomatic patients with low or intermediate estimated pretest probability of having CAD and does not provide additional diagnostic information in patients with a high estimated pretest probability.
We compared the diagnostic accuracy of 64-slice computed tomographic (CT) coronary angiography to detect significant coronary artery disease (CAD) in women and men. The 64-slice CT coronary ...angiography was performed in 402 symptomatic patients, 123 women and 279 men, with CAD prevalence of 51% and 68%, respectively. Significant CAD, defined as ≥50% coronary stenosis on quantitative coronary angiography, was evaluated on a patient, vessel, and segment level. The sensitivity and negative predictive value to detect significant CAD was very good, both for women and men (100% vs 99%, p = NS; 100% vs 98%, p = NS), whereas diagnostic accuracy (88% vs 96%; p <0.01), specificity (75% vs 90%, p <0.05), and positive predictive value (81% vs 95%, p <0.001) were lower in women. The per-segment analysis demonstrated lower sensitivity in women compared with men (82% vs 93%, p <0.001). The sensitivity in women did not show a difference in proximal and midsegments, but was significantly lower in distal segments (56% vs 85%, p <0.05) and side branches (54% vs 89%, p <0.001). In conclusion, CT coronary angiography reliably rules out the presence of obstructive CAD in both men and women. Specificity and positive predictive value of CT coronary angiography were lower in women. The sensitivity to detect stenosis in small coronary branches was lower in women compared with men.
Computed tomographic coronary angiography (CTCA) can noninvasively identify calcified and noncalcified coronary plaques. The aim of this study was to compare the phenotypes of all plaques and of ...culprit plaques between patients with unstable angina pectoris (UAP) and those with stable angina pectoris (SAP), because plaque characteristics may differ between these patients. In 110 patients with UAP and 189 with SAP from a multicenter study comparing 64-slice CTCA with conventional coronary angiography, the number and phenotypes (noncalcified, mixed, and calcified) of coronary plaques were compared. In a subanalysis in 50 patients with UAP and 64 with SAP, culprit plaque characteristics, including culprit plaque cross-sectional area relative to total vessel cross-sectional area, culprit plaque length, remodeling index, and spotty calcification, were determined. Odds ratios for the presence of UAP, adjusted for clinical variables and the total number of plaques, were calculated for plaque characteristics on CTCA. Although the number of plaques was similar for patients with UAP and those with SAP, plaques in patients with UAP were more frequently noncalcified than in patients with SAP. The odds ratio for UAP was 1.3 (95% confidence interval CI 1.1 to 1.5) per noncalcified plaque. In the culprit plaque subanalysis, odds ratios for UAP were 0.99 (95% CI 0.96 to 1.01) per millimeter culprit plaque length, 2.7 (95% CI 1.2 to 6.4) for noncalcified culprit plaque, and 1.06 (95% CI 0.99 to 1.13) per percentage relative culprit plaque cross-sectional area. No significant relation was found between remodeling index or spotty calcification and UAP. In conclusion, noncalcified plaques and large noncalcified culprit plaques are more frequently found in patients with UAP than in those with SAP.
Comprehensive Assessment of Coronary Artery Stenoses Meijboom, W. Bob, MD; Van Mieghem, Carlos A.G., MD; van Pelt, Niels, MD ...
Journal of the American College of Cardiology,
08/2008, Letnik:
52, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Comprehensive Assessment of Coronary Artery Stenoses: Computed Tomography Coronary Angiography Versus Conventional Coronary Angiography and Correlation With Fractional Flow Reserve in Patients With ...Stable Angina W. Bob Meijboom, Carlos A. G. Van Mieghem, Niels van Pelt, Annick Weustink, Francesca Pugliese, Nico R. Mollet, Eric Boersma, Eveline Regar, Robert J. van Geuns, Peter J. de Jaegere, Patrick W. Serruys, Gabriel P. Krestin, Pim J. de Feyter We sought to determine the diagnostic accuracy of noninvasive qualitative (computed tomography coronary angiography CTCA) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. The diagnostic accuracy of CTCA, QCT, conventional coronary angiogram (CCA), and quantitative coronary angiography (QCA) to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R value of, respectively, −0.32 and −0.30). The anatomical assessment of the hemodynamic significance of coronary stenoses determined either by CTCA, CCA, QCT, or QCA does not correlate well with the functional assessment of FFR.
Reply Meijboom, W. Bob, MD; Meijs, Matthijs F.L., MD; Schuijf, Joanne D., MD, PhD ...
Journal of the American College of Cardiology,
2009, Letnik:
53, Številka:
19
Journal Article
Objectives We sought to evaluate the contribution of noninvasive dual-source computed tomography angiography (CTA) in the comprehensive assessment of symptomatic patients after coronary artery bypass ...grafting (CABG). Background Assessment of bypass grafts and distal runoffs by invasive coronary angiography is cumbersome and often requires extra procedure time, contrast load, and radiation exposure. Methods Dual-source CTA was performed in 52 (41 men, mean age 66.6 ± 13.2 years) symptomatic post-CABG patients scheduled for invasive coronary angiography. No oral or intravenous beta blockers or sedation were administered before the scan. Mean interval between CABG surgery and CTA was 9.6 ± 7.2 (range 0 to 20) years. Mean heart rate during scanning was 64.5 ± 13.2 (range 48 to 92) beats/min. Seventy-five percent of patients had both arterial and venous grafts. A total of 152 graft segments and 142 distal runoffs vessels were analyzed. Native coronary segments were divided into nongrafted (n = 118) and grafted segments (n = 289). A significant stenosis was defined as ≥50% lumen diameter reduction, and quantitative coronary angiography served as reference standard. Results The diagnostic accuracy of CTA for the detection or exclusion of significant stenosis in arterial and venous grafts on a segment-by-segment analysis was 100%. Sensitivity, specificity, positive predictive value, and negative predictive value to detect significant stenosis were 95% (95% confidence interval CI: 73% to 100%), 100% (95% CI: 96% to 100%), 100% (95% CI: 79% to 100%), 99% (95% CI: 95% to 100%) in distal runoffs respectively; 100% (95% CI: 97% to 100%), 96% (95% CI: 90% to 98%), 97% (95% CI: 93% to 99%), 100% (95% CI: 95% to 100%) in grafted native coronary arteries respectively; and 97% (95% CI: 83% to 100%), 92% (95% CI: 83% to 96%), 83% (95% CI: 67% to 92%), 99% (95% CI: 92% to 100%) in nongrafted native coronary arteries, respectively. Conclusions Noninvasive CTA is successful for evaluating bypass grafts in symptomatic post-CABG patients, whereas invasive coronary angiography is still required for the assessment of significant stenosis in distal runoffs and native coronary arteries.
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