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Computed tomography coronary angiography in asymptomatic patients

Angiografia coronarica con tomografia computerizzata in individui asintomatici

  • Cardiac Radiology / Cardioradiologia
  • Published:
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Abstract

Purpose

This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; ≥50% lumen reduction) in intermediate/high-risk asymptomatic patients.

Materials and methods

A total of 183 consecutive asymptomatic individuals (92 men; mean age 54±11 years) with more than one major risk factor (obesity, hypertension, diabetes, hypercholesterolaemia, family history, smoking) and an inconclusive or nonfeasible noninvasive stress test result (stress electrocardiography, stress echocardiography, nuclear stress scintigraphy) underwent CT-CA in an outpatient setting. All patients underwent conventional coronary angiography (CAG) within 4 weeks. Data from CT-CA were compared with CAG regarding the presence of significant CAD (≥50% lumen reduction).

Results

Mean calcium score was 177±432, mean heart rate during the CT-CA scan was 58±8 bpm and the prevalence (per-patient) of obstructive CAD was 19%. CT-CA showed single-vessel CAD in 9% of patients, two-vessel CAD in 9% and three-vessel CAD in 0%. Per-patient sensitivity, specificity, positive predictive value and negative predictive value of CT-CA were 100% (90–100), 98% (96–99), 97% (85–99), 100% (97–100), respectively. Positive and negative likelihood ratios were 151 and 0, respectively.

Conclusions

CT-CA is an excellent noninvasive imaging modality for excluding significant CAD in intermediate/ high-risk asymptomatic patients with inconclusive or nonfeasible noninvasive stress test.

Riassunto

Obiettivo

Obiettivo di questo lavoro è stato valutare l’accuratezza diagnostica dell’angiografia coronarica con tomografia computerizzata (CT-CA) nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico >-50%) confrontata con la coronarografia convenzionale (CAG) in una popolazione di soggetti asintomatici a rischio intermedio/alto.

Materiali e metodi

Centottantatre soggetti consecutivi asintomatici (92 maschi e 91 femmine; età media 54±11 anni) con più di un fattore di rischio (obesità, ipertensione arteriosa, diabete mellito, dislipidemia, familiarità, fumo di sigaretta) e stress test inconclusivo o non eseguibile (stress elettrocardiogramma [ECG], stress ecocardiografia, o stress tomografia computerizzata a emissione di fotoni singoli [SPECT]) sono stati sottoposti a CT-CA. Tutti i pazienti sono stati sottoposti a coronarografia convenzionale (CAG) entro 4 settimane dalla CT-CA. I risultati della CT-CA sono stati confrontati con la CAG per la rilevazione di stenosi coronariche significative.

Risultati

Il calcium score medio, la frequenza cardiaca media e la prevalenza di malattia per paziente sono risultati 177±432, 58±8 battiti per minuto (bpm), e 19%, rispettivamente. La CT-CA ha mostrato malattia significativa mono-vasale nell’9% dei casi, bi-vasale nel 9% dei casi, e tri-vasale in nessun paziente. La sensibilità, specificità, valore predittivo positivo della CT-CA per paziente sono risultati 100% (90%–100%), 99% (96%–99%), 97% (85%–99%), 100% (97%–100%), rispettivamente. I likelihood ratio positivo e negativo per paziente sono risultati 151 e 0, rispettivamente.

Conclusioni

La CT-CA è un ottimo strumento per l’esclusione di malattia coronarica significativa nel asintomatico ad intermedio/alto rischio con stress test in conclusivo o non eseguibile.

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References/Bibliografia

  1. Nieman K, Oudkerk M, Rensig BJ et al (2001) Coronary angiography with multislice computed tomography. Lancet 357:599–603

    Article  PubMed  CAS  Google Scholar 

  2. Mollet NR, Cademartiri F, Krestin GP et al (2005) Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. J Am Coll Cardiol 45:128–132

    Article  PubMed  Google Scholar 

  3. Mollet NR, Cademartiri F, Nieman K et al (2004) Multislice spiral CT coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol 43:2265–2270

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Cademartiri F, Malagutti P, Belgrano M et al (2005) Non-invasive coronary angiography with 64-slice computed tomography. Minerva Cardioangiol 53:465–472

    PubMed  CAS  Google Scholar 

  6. Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732

    Article  PubMed  Google Scholar 

  7. Marano R, De Cobelli F, Floriani I et al (2009) Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCADNon Invasive Multicenter Italian Study for Coronary Artery Disease). Eur Radiol 19:1114–1123

    Article  PubMed  Google Scholar 

  8. Miller JM, Dewey M, Vavere AL et al (2009) Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64. Eur Radiol 19:816–828

    Article  PubMed  Google Scholar 

  9. Meijboom WB, Meijs MF, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144

    Article  PubMed  Google Scholar 

  10. Bluemke DA, Achenbach S, Budoff M et al (2008) Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation 118:586–606

    Article  PubMed  Google Scholar 

  11. Lim S, Choi SH, Choi EK et al (2008) Comprehensive evaluation of coronary arteries by multidetector-row cardiac computed tomography according to the glucose level of asymptomatic individuals. Atherosclerosis 205:156–162

    Article  PubMed  Google Scholar 

  12. Rivera JJ, Nasir K, Choi EK et al (2009) Detection of occult coronary artery disease in asymptomatic individuals with diabetes mellitus using non-invasive cardiac angiography. Atherosclerosis 203:442–448

    Article  PubMed  CAS  Google Scholar 

  13. Choi EK, Choi SI, Rivera JJ et al (2008) Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 52:357–365

    Article  PubMed  Google Scholar 

  14. Choi EK, Koo BK, Kim HS et al (2007) Prognostic significance of asymptomatic coronary artery disease in patients with diabetes and need for early revascularization therapy. Diabet Med 24:1003–1011

    Article  PubMed  CAS  Google Scholar 

  15. Romeo F, Leo R, Clementi F et al (2007) Multislice computed tomography in an asymptomatic highrisk population. Am J Cardiol 99:325–328

    Article  PubMed  Google Scholar 

  16. Bachar GN, Atar E, Fuchs S et al (2007) Prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing coronary multidetector computed tomography. Coron Artery Dis 18:353–360

    Article  PubMed  Google Scholar 

  17. Cademartiri F, Runza G, La Grutta L et al (2005) Non-invasive evaluation of coronary calcium. Radiol Med (Torino) 110:506–522

    Google Scholar 

  18. 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 

  19. Cademartiri F, Nieman K, van der Lugt A et al (2004) Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology 233:817–823

    Article  PubMed  Google Scholar 

  20. Cademartiri F, Luccichenti G, Marano R et al (2004) Use of saline chaser in the intravenous administration of contrast material in non-invasive coronary angiography with 16-row multislice Computed Tomography. Radiol Med (Torino) 107:497–505

    Google Scholar 

  21. 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 

  22. Mowatt G, Cummins E, Waugh N et al (2008) Systematic review of the clinical effectiveness and costeffectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess 12:iii–iv, ix-143

    CAS  Google Scholar 

  23. Mowatt G, Cook JA, Hillis GS et al (2008) 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393

    Article  PubMed  CAS  Google Scholar 

  24. Di Tanna GL, Berti E, Stivanello E et al (2008) Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: a systematic review. Int J Cardiol 130:386–404

    Article  PubMed  Google Scholar 

  25. Akram K, Voros S. (2008) Influence of symptoms and age on the predictive value of coronary artery calcium scanning. J Am Coll Cardiol 52:2214

    Article  PubMed  Google Scholar 

  26. Mollet NR, Cademartiri F, Nieman K et al (2005) Noninvasive assessment of coronary plaque burden using multislice computed tomography. Am J Cardiol 95:1165–1169

    Article  PubMed  Google Scholar 

  27. Kelly JL, Thickman D, Abramson SD et al (2008) Coronary CT angiography findings in patients without coronary calcification. AJR Am J Roentgenol 191:50–55

    Article  PubMed  Google Scholar 

  28. Hausleiter J, Meyer T, Hermann F et al (2009) Estimated radiation dose associated with cardiac CT angiography. Jama 301:500–507

    Article  PubMed  CAS  Google Scholar 

  29. Hirai N, Horiguchi J, Fujioka C et al (2008) Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. Radiology 248:424–430

    Article  PubMed  Google Scholar 

  30. Stolzmann P, Leschka S, Scheffel H et al (2008) Dual-source CT in step-andshoot mode: noninvasive coronary angiography with low radiation dose. Radiology 249:71–80

    Article  PubMed  Google Scholar 

  31. Scheffel H, Alkadhi H, Leschka S et al (2008) Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart 94:1132–1137

    Article  PubMed  CAS  Google Scholar 

  32. Shuman WP, Branch KR, May JM et al (2008) Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology 248:431–437

    Article  PubMed  Google Scholar 

  33. Cademartiri F, Maffei E, Notarangelo F et al (2008) 64-slice computed tomography coronary angiography: diagnostic accuracy in the real world. Radiol Med 113:163–180

    Article  PubMed  CAS  Google Scholar 

  34. Cademartiri F, Maffei E, Palumbo A et al (2007) Diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low-to-intermediate risk. Radiol Med 112:969–981

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Cardiology, c/o Piastra Tecnica, Piano 0, Azienda Ospedaliero-Universitaria, Via Gramsci 14, 43100, Parma, Italy

    E. Maffei, A. Palumbo, C. Martini & F. Cademartiri

  2. Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands

    A. Palumbo, C. Martini, A. C. Weustink, N. R. Mollet & F. Cademartiri

  3. Department of Radiology and Cardiology, Ospedale San Gennaro, Napoli, Italy

    C. Tedeschi & R. De Rosa

  4. Department of Radiology, Università di Messina, Messina, Italy

    T. Arcadi, I. Salamone & A. Blandino

  5. Department of Radiology, Università di Palermo, Palermo, Italy

    L. La Grutta & M. Midiri

  6. Department of Radiology, Università di Verona, Verona, Italy

    R. Malagò

  7. Department of Radiology, SDN-IRCCS Foundation, Napoli, Italy

    O. Catalano

Authors
  1. E. Maffei
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  2. A. Palumbo
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  3. C. Martini
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  4. C. Tedeschi
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  5. T. Arcadi
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  6. L. La Grutta
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  7. R. Malagò
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  8. A. C. Weustink
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  9. N. R. Mollet
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  10. R. De Rosa
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  11. O. Catalano
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  12. I. Salamone
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  13. A. Blandino
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  14. M. Midiri
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  15. F. Cademartiri
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Corresponding author

Correspondence to F. Cademartiri.

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Maffei, E., Palumbo, A., Martini, C. et al. Computed tomography coronary angiography in asymptomatic patients. Radiol med 116, 1161–1173 (2011). https://doi.org/10.1007/s11547-011-0723-4

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  • DOI: https://doi.org/10.1007/s11547-011-0723-4

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