This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.10.066v1 49/9/946    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Meyer, T. S. Articles by Hausleiter, J. Search for Related Content PubMed PubMed Citation Articles by Meyer, T. S. Articles by Hausleiter, J. Related Collections Related Article

CLINICAL RESEARCH: COMPUTED TOMOGRAPHY ANGIOGRAPHY

Improved Noninvasive Assessment of Coronary Artery Bypass Grafts With 64-Slice Computed Tomographic Angiography in an Unselected Patient Population

Tanja S. Meyer, MD^_*, Stefan Martinoff, MD^_*, Martin Hadamitzky, MD, Albrecht Will, MD^_*, Adnan Kastrati, MD, Albert Schömig, MD and Jörg Hausleiter, MD^,_*

^_* Institut für Radiologie und Nuklearmedizin
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der TU München, Munich, Germany

Manuscript received May 24, 2006; revised manuscript received September 18, 2006, accepted October 9, 2006.

^_* Reprint requests and correspondence: Dr. Jörg Hausleiter, Deutsches Herzzentrum München, Lazarettstrasse 36, 80636 München, Germany. (Email: hausleiter{at}dhm.mhn.de).

OBJECTIVES: In this prospective evaluation we investigated the accuracy of 64-slice computed tomography angiography (CTA) in an unselected but symptomatic patient population for detection of stenoses in bypass grafts when compared with invasive angiography.

BACKGROUND: The assessment of significant stenosis in bypass grafts is important for patients with recurrent angina symptoms after bypass surgery.

METHODS: High-resolution 64-slice computed tomography (0.6 mm collimation, 330 ms gantry rotation time) and invasive angiography were performed in 138 consecutive patients with a total of 418 bypass grafts. Relevant stenosis was defined as diameter reduction 50%. During CTA, arrhythmias were present in 42 (30%) patients who were not excluded from the analysis.

RESULTS: The assessment of stenosis or occlusion of bypass grafts resulted in a sensitivity of 97%, specificity of 97%, and positive and negative predictive values of 93% and of 99%, respectively. The diagnostic accuracy for the detection of graft occlusion or stenosis did not differ between arterial and venous grafts. The evaluability of bypass grafts was significantly lower in patients with arrhythmias or with heart rates 65 beats/min during scanning. However, in the assessment of evaluable bypass grafts, no significant differences were detected in the diagnostic accuracy in these subgroups.

CONCLUSIONS: This large prospective study demonstrates that 64-slice CTA is a reliable method for the assessment of bypass graft patency and stenoses even in an unselected "real-world" patient population.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CI = confidence interval   CT = computed tomography   CTA = computed tomography angiography   IMA = internal mammary artery   MSCT = multislice computed tomography   NPV = negative predictive value   PPV = positive predictive value

Related Article

Integrating Multidetector Computed Tomography Into Clinical Practice: Computed Tomography Scanning Shows its Metal

Basil S. Lewis and David A. Halon
J. Am. Coll. Cardiol. 2007 49: 960-962. [Full Text] [PDF]

This article has been cited by other articles:

				D. A. Bluemke, S. Achenbach, M. Budoff, T. C. Gerber, B. Gersh, L. D. Hillis, W. G. Hundley, W. J. Manning, B. F. Printz, M. Stuber, et al. 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, July 29, 2008; 118(5): 586 - 606. [Full Text] [PDF]

				W T Roberts, J J Bax, and L C Davies Cardiac CT and CT coronary angiography: technology and application Heart, June 1, 2008; 94(6): 781 - 792. [Abstract] [Full Text] [PDF]

				M. Hamon, O. Lepage, P. Malagutti, J. W. Riddell, R. Morello, D. Agostini, and M. Hamon Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery Bypass Graft Assessment: Meta-Analysis Radiology, June 1, 2008; 247(3): 679 - 686. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				B. S. Lewis and D. A. Halon Integrating Multidetector Computed Tomography Into Clinical Practice: Computed Tomography Scanning Shows its Metal J. Am. Coll. Cardiol., March 6, 2007; 49(9): 960 - 962. [Full Text] [PDF]