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.
Objectives This study sought to analyze the natural history of coronary atherosclerosis by multislice computed tomography (MSCT) and assess the serial changes in coronary plaque burden, lumen ...dimensions, and arterial remodeling. Background MSCT can comprehensively assess coronary atherosclerosis by combining lumen and plaque size parameters. Methods Thirty-two patients with acute coronary syndromes underwent 64-slice computed tomography angiography after percutaneous coronary intervention at baseline and after a median of 39 months. All patients received contemporary medical treatment. All available coronary segments in every subject were analyzed. The progression of atherosclerosis per segment and per patient was assessed by means of change in percent atheroma volume (PAV), change in normalized total atheroma volume (TAVnorm), and percent change in TAV (% change in TAV). Serial coronary remodeling was also assessed. Measures of lumen stenosis included percent diameter stenosis (%DS), minimum lumen diameter (MLD), percent area stenosis (%AS), and minimum lumen area (MLA). For each patient, the mean of all matched segments was calculated at the 2 time points. Clinical events at follow-up were documented. Results The PAV did not change significantly (−0.15 ± 3.64%, p = 0.72). The mean change in TAVnorm was 47.36 ± 143.24 mm3 (p = 0.071), and the % change in TAV was 6.7% (p = 0.029). The MLD and MLA increased by 0.15 mm (−0.09 to 0.24, p = 0.039) and 0.52 mm2 (−0.38 to 1.04, p = 0.034) respectively, which was accompanied by vessel enlargement, with 53% of the patients showing expansive positive remodeling. Patients with clinical events had a larger TAVnorm at baseline (969.72 mm3 vs. 810.77 mm3 , p = 0.010). Conclusions MSCT can assess the progression of coronary atherosclerosis and may be used for noninvasive monitoring of pharmacological interventions in coronary artery disease. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466 )
Usefulness of 64-Slice Multislice Computed Tomography Coronary Angiography to Assess In-Stent Restenosis Filippo Cademartiri, Joanne D. Schuijf, Francesca Pugliese, Nico R. Mollet, J. Wouter Jukema, ...Erica Maffei, Lucia J. Kroft, Alessandro Palumbo, Diego Ardissino, Patrick W. Serruys, Gabriel P. Krestin, Ernst E. Van der Wall, Pim J. de Feyter, Jeroen J. Bax The purpose of the present study was to evaluate the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) coronary angiography in the follow-up of patients with previous coronary stent implantation. In 182 patients with 192 previously implanted stents, 64-slice MSCT angiography was performed in addition to quantitative coronary angiography to evaluate the presence of in-stent restenosis (≥50%). In total, 14 (7.3%) stents were uninterpretable. In the interpretable stents, sensitivity, specificity, and positive and negative predictive value to identify in-stent restenosis were 95.0%, 93.0%, 63.3%, and 99.3%, respectively. Accordingly, 64-slice MSCT may be valuable as a noninvasive method of excluding in-stent restenosis.
Reliable High-Speed Coronary Computed Tomography in Symptomatic Patients Annick C. Weustink, Willem B. Meijboom, Nico R. Mollet, Masato Otsuka, Fransesca Pugliese, Carlos van Mieghem, Roberto Malago, ...Niels van Pelt, Marcel L. Dijkshoorn, Filippo Cademartiri, Gabriel P. Krestin, Pim J. de Feyter We assessed the diagnostic performance of the high-speed dual source computed tomography scanner (DSCT) for the detection of significant coronary lesions in a clinically wide range of patients. Sensitivity, specificity, and positive and negative predictive values of DSCT coronary angiography for the detection of significant lesions on a segment-by-segment analysis were 95%, 95%, 75%, and 99%, respectively, and on a patient-based analysis 99%, 87%, 96%, and 95%, respectively. Noninvasive DSCT coronary angiography is highly sensitive to detect and to reliably rule out the presence of a significant coronary stenosis in patients presenting with atypical or typical angina pectoris, or unstable coronary artery disease.
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.
The aim of this study was to investigate the value of coronary calcium detection by computed tomography compared to computed tomographic angiography (CTA) and exercise testing to detect obstructive ...coronary artery disease (CAD) in patients with stable chest pain. A total of 471 consecutive patients with new stable chest complaints were scheduled to undergo dual-source multislice computed tomography (Siemens, Germany; coronary calcium score CCS and coronary CTA) and exercise electrocardiography (XECG). Clinically driven invasive quantitative angiography was performed in 98 patients. Only 3 of 175 patients (2%) with a negative CCS had significant CAD on CT angiogram, with only 1 confirmed by quantitative angiography. In patients with a high calcium score (Agatston score >400), CTA could exclude significant CAD in no more than 4 of 65 patients (6%). In patients with a low–intermediate CCS, CTA more often yielded diagnostic results compared to XECG and could rule out obstructive CAD in 56% of patients. For patients with CAD on CT angiogram, those with abnormal exercise electrocardiographic results more often showed severe CAD (p <0.034). In patients with diagnostic results for all tests, the sensitivity and specificity to detect >50% quantitative angiographic diameter stenosis were 100% and 15% for CCS >0, 82% and 64% for CCS >100, 97% and 36% for CTA, and 70% and 76% for XECG, respectively. In conclusion, nonenhanced computed tomography for calcium detection is a reliable means to exclude obstructive CAD in stable, symptomatic patients. Contrast-enhanced CTA can exclude significant CAD in patients with a low–intermediate CCS but is of limited value in patients with a high CCS.
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
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.
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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