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Computed tomography coronary angiography vs. stress ECG in patients with stable angina

Coronarografia con tomografia computerizzata vs ECG da sforzo nell’angina stabile

  • Cardiac Radiology/Cardioradiologia
  • Published:
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Abstract

Purpose

This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain.

Materials and methods

MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8±7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate ≥70 beats/minute. In order to identify or exclude patients with significant stenoses (≥50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test.

Results

The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0–5.3] and 0.3 (95% CI: 0.2–0.7) for the stress test and 10.0 (95% CI: 1.8–78.4) and 0.0 (95% CI: 0.0-∞) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD.

Conclusions

Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD.

Riassunto

Obiettivo

Confrontare il ruolo dell’angiografia coronarica mediante tomografia computerizzata multistrato (ACTCMS) e della prova da sforzo con ECG nell’iter diagnostico dei pazienti con angina stabile.

Materiali e metodi

L’AC-TCMS è stata eseguita in 43 pazienti (31 uomini, 12 donne, età media 58,8±7,7 anni) con angina stabile sottoposti ad iter diagnostico comprendente la prova da sforzo con ECG e l’angiografia coronarica convenzionale. Sono stati rispettati i seguenti criteri d’inclusione: ritmo cardiaco sinusale, capacità di mantenere l’apnea inspiratoria per almeno 12 secondi. Si è ricorso alla somministrazione di β-bloccanti nei pazienti con ritmo ≥70 bpm/minuto. Allo scopo di identificare o escludere i pazienti con stenosi significative (lume ≥50%) sono stati determinati i rapporti di verosimiglianza post-test della prova da sforzo e dell’AC-TCMS indipendentemente, e dell’AC-TCMS eseguita dopo il test da sforzo.

Risultati

La probabilità pre-test di una significativa coronaropatia aterosclerotica (CA) è risultata del 74%. I rapporti di verosimiglianza positivo e negativo sono risultati rispettivamente 2,3 (95% IC: 1,0–5,3) e 0,3 (95% IC: 0,2–0,7) per il test da sforzo, 10,0 (95% IC: 1,8–78,4) e 0,0 (95% IC: 0,0-∞) per l’AC-TCMS. L’AC-TCMS ha migliorato la probabilità post-test di una rilevante CA dal 50% fino all’86% dopo una prova da sforzo negativa, e dall’88% fino al 100% dopo una prova da sforzo positiva; l’AC-TCMS ha correttamente identificato tutti i pazienti senza CA.

Conclusioni

L’AC-TCMS é uno strumento non invasivo potenzialmente utile nell’iter diagnostico dei pazienti con angina stabile in grado di rendere nota od escludere una significativa CA.

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Authors and Affiliations

  1. Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    F. Cademartiri, A. Palumbo, E. Maffei, C. Martini, S. Seitun & A. Aldrovandi

  2. Dipartimento di Radiologia e Cardiologia, Erasmus Medical Center, Rotterdam, The Netherlands

    F. Cademartiri, L. La Grutta, A. Palumbo, C. Martini, M. Belgrano, N. Mollet & A. Weustink

  3. DIBIMEL, Sezione di Scienze Radiologiche, Università di Palermo, Palermo, Italy

    L. La Grutta & M. Midiri

  4. Dipartimento di Ostetricia e Ginecologia e Scienze radiologiche dell’Università di Catania, Catania, Italy

    F. Coppolino

  5. Dipartimento di Radiologia, Università degli Studi di Trieste, Trieste, Italy

    M. Belgrano & M. Cova

  6. Dipartimento di Radiologia, Università degli Studi di Verona, Verona, Italy

    R. Malagò

  7. Dipartimento di Radiologia, c/o Piastra Tecnica — Piano 0, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Parma, Italy

    F. Cademartiri

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  1. F. Cademartiri
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  2. L. La Grutta
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  3. A. Palumbo
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  4. E. Maffei
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  5. C. Martini
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  6. S. Seitun
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  7. F. Coppolino
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  8. M. Belgrano
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  9. R. Malagò
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  10. A. Aldrovandi
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  11. N. Mollet
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  12. A. Weustink
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  13. M. Cova
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  14. M. Midiri
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Correspondence to F. Cademartiri.

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Cademartiri, F., La Grutta, L., Palumbo, A. et al. Computed tomography coronary angiography vs. stress ECG in patients with stable angina. Radiol med 114, 513–523 (2009). https://doi.org/10.1007/s11547-009-0388-4

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  • DOI: https://doi.org/10.1007/s11547-009-0388-4

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