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CLINICAL RESEARCH: CARDIAC IMAGING

Reliable High-Speed Coronary Computed Tomography in Symptomatic Patients

Annick C. Weustink, MD^_*,, Willem B. Meijboom, MD^_*,, Nico R. Mollet, MD, PhD^_*,, Masato Otsuka, MD^_*, Fransesca Pugliese, MD^_*,, Carlos van Mieghem, MD^_*,, Roberto Malago, MD, Niels van Pelt, MD^_*,, Marcel L. Dijkshoorn, BSc, Filippo Cademartiri, MD, PhD^_*,, Gabriel P. Krestin, MD, PhD and Pim J. de Feyter, MD, PhD^_*,,_*

^_* Department of Cardiology, Thoraxcenter, Rotterdam, the Netherlands
Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.

Manuscript received December 28, 2006; revised manuscript received April 18, 2007, accepted April 24, 2007.

^_* Reprint requests and correspondence: Dr. Pim J. de Feyter Department of Cardiology and Radiology, Thoraxcenter, Room Ba 589, ’s Gravendijkwal 230, 3000 CA Rotterdam, the Netherlands. (Email: p.j.defeyter{at}erasmusmc.nl).

Objectives: Our objective was to prospectively evaluate the diagnostic performance of the high-speed dual-source computed tomography scanner (DSCT), with an increased temporal resolution (83 ms), for the detection of significant coronary lesions (50% lumen diameter reduction) in a clinically wide range of patients.

Background: Cardiac motion artifacts may decrease coronary image quality with use of earlier computed tomography scanners that have a limited temporal resolution.

Methods: We prospectively studied 100 symptomatic patients (79 men, 21 women, mean age 61 ± 11 years) with atypical (18%) or typical (55%) angina pectoris, or unstable coronary artery disease (27%) scheduled for conventional coronary angiography. Mean scan time was 8.58 ± 1.52 s. Mean heart rate was 68 ± 11 beats/min. Quantitative coronary angiography was used as the standard of reference. Irrespective of image quality or vessel size, all segments were included for analysis.

Results: Invasive coronary angiography demonstrated no significant disease in 23%, single-vessel disease in 31%, and multivessel disease in 46% of patients; 1,489 coronary segments, containing 220 significant (14.8%) stenoses, were available for analysis. Sensitivity, specificity, and positive and negative predictive values of DSCT coronary angiography for the detection of significant lesions on a segment-by-segment analysis were 95% (95% confidence interval [CI] 90 to 97), 95% (95% CI 93 to 96), 75% (95% CI 69 to 80), 99% (95% CI 98 to 99), respectively, and on a patient-based analysis 99% (95% CI 92 to 100), 87% (95% CI 65 to 97), 96% (95% CI 89 to 99), and 95% (95% CI 74 to 100), respectively.

Conclusions: Noninvasive DSCT coronary angiography is highly sensitive to detect and to reliably rule out the presence of a significant coronary stenosis in patients presenting with atypical or typical angina pectoris, or unstable coronary artery disease.

Abbreviations and Acronyms   CCA = conventional coronary angiography   CI = confidence interval   CT = computed tomography   DSCT = dual-source computed tomography scanner   QCA = quantitative coronary angiography

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