Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores

M. A.S. Cordeiro, J. M. Miller, A. Schmidt, A. C. Lardo, B. D. Rosen, D. E. Bush, J. A. Brinker, D. A. Bluemke, E. P. Shapiro, J. A.C. Lima

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To show an overall diagnostic accuracy ≥ 90% for detection of ≥ 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. Methods: ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm 3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m 2). Native arteries, including ≥ 1.5 mm branches, and bypass grafts were screened for ≥ 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography. Results: Median Agatston calcium score was 510 (range 3-5066). Sensitivity, specificity, and positive and negative predictive values for detection of ≥ 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Conclusions: Coronary 32 x 0.5-MDCTA accurately excludes ≥ 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

Original languageEnglish (US)
Pages (from-to)589-597
Number of pages9
JournalHeart
Volume92
Issue number5
DOIs
StatePublished - May 2006

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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