Diagnostic Accuracy of 64-Slice Multislice Computed Tomographic Coronary Angiography in Patients With an Intermediate Pretest Likelihood for Coronary Artery Disease

Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
The American journal of cardiology (Impact Factor: 3.28). 02/2010; 105(3):302-5. DOI: 10.1016/j.amjcard.2009.09.029
Source: PubMed


Data on the diagnostic accuracy of multislice computed tomographic coronary angiography (CTA) have been mostly derived from patients with a high pretest likelihood of coronary artery disease. Systematic comparisons with invasive angiography in patients with an intermediate pretest likelihood are scarce. The purpose of the present study was to determine the diagnostic accuracy of CTA in patients without known coronary artery disease with an intermediate pretest likelihood. A total of 61 patients (61% men, average age 57 + or - 9 years) who had been referred for invasive coronary angiography underwent additional 64-slice CTA. A total of 920 segments were identified by invasive coronary angiography, of which 885 (96%) were interpretable on CTA. Invasive coronary angiography identified a significant stenosis (> or = 50% luminal narrowing) in 29 segments, of which 23 were detected on CTA. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value was 79%, 98%, 61%, and 99%, respectively, for CTA. On a patient level, the sensitivity, specificity, positive predictive value, and negative predictive value was 100%, 89%, 76%, and 100%, respectively. CTA correctly ruled out the presence of significant stenosis in 40 (66%) of the 61 patients. In conclusion, the results from the present study have confirmed that CTA has excellent diagnostic accuracy in the target population of patients with an intermediate pretest likelihood. The high negative predictive value allowed us to rule out significant stenosis in a large proportion of patients. CTA can, therefore, be used as a highly effective gatekeeper for invasive coronary angiography.

8 Reads
  • Source
    • "It is reasonable to consider that CCTA was apparently less invasive than intravascular imaging techniques. In addition, recent studies showed the plaque exhibiting positive remodeling and low-attenuation on CCTA was consistent with vulnerable plaque on intravascular ultrasound [12] [19] [20]. Soeda et al evaluated coronary plaque with CCTA before and after statin therapy for 24 weeks [21], and found that CTdetermined plaque composition could be changed 24 weeks or 6 months after statin therapy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although intensive lipid lowering by statins can enhance plaque stability, few data exist regarding how early statins change plaque composition and morphology in clinical setting. Therefore, to examine early changes in plaque composition and morphology by intensive lipid lowering with statins, we evaluate coronary plaques from acute coronary syndrome (ACS) before and 3 weeks after lipid lowering by coronary CT angiography. We enrolled 110 patients with suspected ACS and underwent coronary CT. We defined plaque as unstable when CT number of plaque< 50HU and remodeling index (lesion diameter/reference diameter) >1.10. Rosuvastatin (5 mg/day) or atorvastatin (20 mg/day) were introduced to reduce low density lipoprotein cholesterol (LDL-C). Then, CT was again performed by the same condition 3 weeks after lipid lowering therapy. Total 10 patients (8 men, mean age 72.0 years), in whom informed consent regarding serial CT examination was obtained, were analyzed. Among them, 4 patients who denied to have intensive lipid lowering were served as controls. In remaining 6 patients, LDL-C reduced from 129.5±26.9 mg/dl to 68.5±11.1 mg/dl after statin treatment. Under these conditions, CT number of the targeted plaque significantly increased from 16.0±15.9 to 50.8±35.0 HU (p<0.05) and remodeling index decreased from 1.22±0.11 to 1.11±0.06 (p<0.05), although these values substantially unchanged in controls. These results demonstrate that MDCT-determined plaque composition as well as volume could be changed within 3 weeks after intensive lipid lowering. This may explain acute effects of statins in treatment of acute coronary syndrome.
    American Journal of Cardiovascular Disease 06/2012; 2(2):84-8.
  • Source
    • "ICA was only performed in 42 patients, so the presence of significant CAD could not be entirely ruled out in the present study population. Although CTCA is an excellent tool for ruling out significant CAD with a negative predictive value of 97% to 99% [33], some patients with haemodynamically significant coronary lesions may have been included. Second, subjects with obstructive CAD were not included in the current study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There has been increasing interest in quantitative myocardial blood flow (MBF) imaging over the last years and it is expected to become a routinely used technique in clinical practice. Positron emission tomography (PET) using [(15)O]H(2)O is the established gold standard for quantification of MBF in vivo. A fundamental issue when performing quantitative MBF imaging is to define the limits of MBF in a clinically suitable population. The aims of the present study were to determine the limits of MBF and to determine the relationship among coronary artery disease (CAD) risk factors, gender and MBF in a predominantly symptomatic patient cohort without significant CAD. A total of 128 patients (mean age 54 ± 10 years, 50 men) with a low to intermediate pretest likelihood of CAD were referred for noninvasive evaluation of CAD using a hybrid PET/computed tomography (PET/CT) scanner. MBF was quantified with [(15)O]H(2)O at rest and during adenosine-induced hyperaemia. Obstructive CAD was excluded in these patients by means of invasive or CT-based coronary angiography. Global average baseline MBF values were 0.91 ± 0.34 and 1.09 ± 0.30 ml·min(-1)·g(-1) (range 0.54-2.35 and 0.59-2.75 ml·min(-1)·g(-1)) in men and women, respectively (p < 0.01). However, no gender-dependent difference in baseline MBF was seen following correction for rate-pressure product (0.98 ± 0.45 and 1.09 ± 0.30 ml·min(-1)·g(-1) in men and women, respectively; p = 0.08). Global average hyperaemic MBF values were 3.44 ± 1.20 ml·min(-1)·g(-1) in the whole study population, and 2.90 ± 0.85 and 3.78 ± 1.27 ml·min(-1)·g(-1) (range 1.52-5.22 and 1.72-8.15 ml·min(-1)·g(-1)) in men and women, respectively (p < 0.001). Multivariate analysis identified male gender, age and body mass index as having an independently negative impact on hyperaemic MBF. Gender, age and body mass index substantially influence reference values and should be corrected for when interpreting hyperaemic MBF values.
    European Journal of Nuclear Medicine 01/2012; 39(1):102-12. DOI:10.1007/s00259-011-1956-0 · 5.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Palladium supported on Si-stabilised alumina has been demonstrated to be an active and durable catalyst for the combustion of methane. Si is more effective in stabilising alumina than La or Ba when the elements are added through an impregnation technique. Multiple stabilisation with combinations of La, Ba and Si does not increase further the stability against sintering. The stability increases logarithmically with the amount of Si added (0.5–8 atomic%). The rate of sintering is not affected by an increase of the water vapour content of the atmosphere from 1 to 20 vol.%. Doping palladium with rhodium or platinum increases the activity of the catalyst for methane combustion. The high-temperature stability of pure Pd is however superior to the stabilities of the Rh- and Pt-doped catalysts. Addition of La or Ce to the Pd-catalyst increases its stability against thermal deactivation but leads to an overall decrease in activity. The activity of the as-prepared catalysts are affected by the Pd-content below a value corresponding to 5% of the monolayer capacity. Thermally deactivated catalysts show a stronger activity dependence of the Pd-content than asprepared catalysts. The combustion reaction is first order with respect to methane and zero-order with respect to oxygen (>2 vol.% of oxygen). Carbon dioxide has no inhibitory effects on the combustion. The activity of the Pd-catalyst is decreased by a factor of 5 through deactivation at 1473 K for 768 h. The decrease in activity is linearly correlated to the decrease in specific surface area.
    Applied Catalysis A General 05/1997; 153(1-2-153):157-175. DOI:10.1016/S0926-860X(96)00328-6 · 3.94 Impact Factor
Show more