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Impact of hypertension on the diagnostic accuracy of coronary angiography with computed tomography

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Abstract

Objective Hypertension induces coronary artery disease (CAD) and progression of arterial wall calcification. As coronary calcifications may cause artefacts in 64-slice computed tomography coronary angiography (CTCA), we sought to determine the diagnostic accuracy of CTCA in patients with and without arterial hypertension. Methods Eighty-five consecutive patients with suspected CAD underwent CTCA, calcium-scoring and conventional coronary angiography, and were grouped as hypertensive (28 women, 31 men, mean age 65 ± 9 years, age range 49–82 years) or normotensive patients (10 women, 16 men, mean age 62 ± 11 years, age range 39–77 years). On an intention-to-diagnose-basis, no coronary segment was excluded and non-evaluative segments were rated as false positive. Results Per-patient sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in the hypertensive group were 91.4, 83.3, 88.9, and 86.9%, while the respective values in the normotensive group were 100, 78.9, 63.6, and 100% (P = 0.42, 0.71, 0.05, and 0.15). In the hypertensive group the prevalence of CAD was 59% and the mean calcium-score was 256; respective values in the normotensive group were 27% and 69, (P < 0.01, and < 0.05 vs. hypertensives). Conclusions Although hypertensives have significantly higher coronary calcifications, sensitivity and specificity are comparably high as in normotensives. The prevalence of CAD is higher in hypertensives and brings about a trend towards a lower NPV and a higher PPV.

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Abbreviations

CAD:

Coronary artery disease

CTCA:

Computed tomography coronary angiography

CCA:

Conventional coronary angiography

References

  1. Leschka S, Alkadhi H, Plass A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487

    Article  PubMed  Google Scholar 

  2. Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154

    Article  PubMed  Google Scholar 

  3. Raff GL, Gallagher MJ, O’Neill WW et al (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557

    Article  PubMed  Google Scholar 

  4. Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323

    Article  PubMed  Google Scholar 

  5. Pugliese F, Mollet NR, Runza G et al (2006) Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol 16:575–582

    Article  PubMed  Google Scholar 

  6. Nikolaou K, Knez A, Rist C et al (2006) Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. AJR Am J Roentgenol 187:111–117

    Article  PubMed  Google Scholar 

  7. Ong TK, Chin SP, Liew CK et al (2006) Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. Am Heart J 151:1323 e1321–e1326

    Google Scholar 

  8. Ehara M, Surmely JF, Kawai M et al (2006) Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population: comparison with conventional invasive angiography. Circ J 70:564–571

    Article  PubMed  Google Scholar 

  9. Ropers D, Rixe J, Anders K et al (2006) Usefulness of multidetector row spiral computed tomography with 64- × 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 97:343–348

    Article  PubMed  Google Scholar 

  10. Meijboom WB, Mollet NR, Van Mieghem CA et al (2007) 64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Heart 93:1386–1392

    Article  PubMed  Google Scholar 

  11. Scheffel H, Alkadhi H, Plass A et al (2006) Accuracy of dual-source CT coronary angiography: First experience in a high pre-test probability population without heart rate control. Eur Radiol 16:2739–2747

    Article  PubMed  Google Scholar 

  12. Herzog C, Zwerner PL, Doll JR et al (2007) Significant coronary artery stenosis: comparison on per-patient and per-vessel or per-segment basis at 64-section CT angiography. Radiology 244:112–120

    Article  PubMed  Google Scholar 

  13. Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791

    Article  PubMed  Google Scholar 

  14. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR (2006) Appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. A Report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group. J Am Coll Radiol 3:751–771

    Article  Google Scholar 

  15. Fox K, Garcia MA, Ardissino D et al (2006) Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 27:1341–1381

    Article  PubMed  Google Scholar 

  16. MacMahon S, Peto R, Cutler J et al (1990) Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335:765–774

    Article  PubMed  CAS  Google Scholar 

  17. Rutan GH, Kuller LH, Neaton JD et al (1988) Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. Circulation 77:504–514

    PubMed  CAS  Google Scholar 

  18. Megnien JL, Simon A, Lemariey M et al (1996) Hypertension promotes coronary calcium deposit in asymptomatic men. Hypertension 27:949–954

    PubMed  CAS  Google Scholar 

  19. Motro M, Shemesh J (2001) Calcium channel blocker nifedipine slows down progression of coronary calcification in hypertensive patients compared with diuretics. Hypertension 37:1410–1413

    PubMed  CAS  Google Scholar 

  20. Miwa Y, Tsushima M, Arima H et al (2004) Pulse pressure is an independent predictor for the progression of aortic wall calcification in patients with controlled hyperlipidemia. Hypertension 43:536–540

    Article  PubMed  CAS  Google Scholar 

  21. Kuettner A, Trabold T, Schroeder S et al (2004) Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol 44:1230–1237

    PubMed  Google Scholar 

  22. Messerli FH, Williams B, Ritz E (2007) Essential hypertension. Lancet 370:591–603

    Article  PubMed  CAS  Google Scholar 

  23. Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  PubMed  CAS  Google Scholar 

  24. Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40

    PubMed  CAS  Google Scholar 

  25. Leschka S, Wildermuth S, Boehm T et al (2006) Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality. Radiology 241:378–385

    Article  PubMed  Google Scholar 

  26. Husmann L, Valenta I, Gaemperli O et al (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29:191–197

    Article  PubMed  Google Scholar 

  27. Garcia MJ, Lessick J, Hoffmann MH (2006) Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. JAMA 296:403–411

    Article  PubMed  CAS  Google Scholar 

  28. Cademartiri F, La Grutta L, Runza G et al (2007) Influence of convolution filtering on coronary plaque attenuation values: observations in an ex vivo model of multislice computed tomography coronary angiography. Eur Radiol 17:1842–1849

    Article  PubMed  Google Scholar 

  29. Seifarth H, Raupach R, Schaller S et al (2005) Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter. Eur Radiol 15:721–726

    Article  PubMed  Google Scholar 

  30. Schuijf JD, Bax JJ, Jukema JW et al (2005) Noninvasive evaluation of the coronary arteries with multislice computed tomography in hypertensive patients. Hypertension 45:227–232

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Lars Husmann, Ines Valenta, Tiziano Schepis, Oliver Gaemperli, Ursina Aepli, Patrick T. Siegrist & Philipp A. Kaufmann

  2. Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland

    Lars Husmann, Hans Scheffel, Sebastian Leschka, Lotus Desbiolles, Paul Stolzmann, Borut Marincek & Hatem Alkadhi

  3. Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

    Philipp A. Kaufmann

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  1. Lars Husmann
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  2. Hans Scheffel
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Correspondence to Philipp A. Kaufmann.

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Husmann, L., Scheffel, H., Valenta, I. et al. Impact of hypertension on the diagnostic accuracy of coronary angiography with computed tomography. Int J Cardiovasc Imaging 24, 763–770 (2008). https://doi.org/10.1007/s10554-008-9307-3

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  • DOI: https://doi.org/10.1007/s10554-008-9307-3

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