Do risk factors influence the diagnostic accuracy of noninvasive coronary angiography with multislice computed tomography?

doi:10.1016/j.nuclcard.2006.05.019

Journal of Nuclear Cardiology

Volume 13, Issue 5, September 2006, Pages 635-641

https://doi.org/10.1016/j.nuclcard.2006.05.019 Get rights and content

Background

Multislice computed tomography (MSCT) is a relatively new noninvasive imaging modality in the evaluation of patients with suspected coronary artery disease (CAD). Whether diagnostic accuracy is influenced by gender or risk factors for CAD is currently unknown and was evaluated in this study.

Methods and Results

In 197 patients (171 men and 26 women; mean age, 60 ± 11 years) 16-slice MSCT was performed and compared with invasive coronary angiography at 2 different centers (Leiden and Rotterdam, The Netherlands). Diagnostic accuracy for the detection of 50% luminal narrowing or greater was calculated for all patients combined, as well as for patients with known versus suspected CAD. In addition, diagnostic accuracy was determined in men versus women and in different subsets of patients based on the presence of risk factors for CAD including hypertension, type 2 diabetes mellitus, hypercholesterolemia, and obesity. Only segments with a diameter of 2.0 mm or greater were evaluated, whereas smaller segments and stents were excluded from the analysis. Overall, a sensitivity and specificity of 99% and 86%, respectively, on a patient level were demonstrated, with corresponding positive and negative predictive values of 95% and 96%, respectively. Similar values were observed in the different subsets of patients, with no statistical differences.

Conclusion

These findings confirm the high diagnostic accuracy of MSCT, regardless of gender or risk factors.

Section snippets

Study Population

A total of 201 patients who presented with known or suspected CAD (based on symptoms or multiple risk factors for CAD [or both]) and were scheduled to undergo invasive coronary angiography for diagnostic purposes were included at 2 different centers (Rotterdam and Leiden, The Netherlands). The following exclusion criteria were applied: renal insufficiency (serum creatinine >120 μmol/L [1.35 mg/dL]) or other contraindications to the administration of iodinated contrast, pregnancy, acute coronary

Clinical Features

In total, 201 patients were evaluated with MSCT, 128 in Rotterdam⁸ and 73 in Leiden.⁹ A subset of patients has been included in previous studies.8, 9 MSCT was performed successfully in all but 2 patients. In these 2 patients the examination could not be evaluated because of technical issues. In 2 other patients all 3 vessels were stented, and these patients were excluded from the analysis as well. The main clinical features of the remaining 197 patients are presented in Table 1.

Coronary Angiography in All Patients

On the basis of

Discussion

The results of this study demonstrate the clinical value of MSCT in the assessment of patients presenting with chest pain. In line with previous reported results a sensitivity and specificity of 90% and 96%, respectively, on a segmental level were observed in the entire study population. Similar to other studies, the diagnostic accuracy of MSCT for the detection of significant CAD differed between analyses on a patient and segmental level.¹⁰ Whereas specificity and negative predictive value

Acknowledgment

The authors have indicated they have no financial conflicts of interest.

References (17)

K. Nieman et al.
Coronary angiography with multi-slice computed tomography
Lancet
(2001)
J.D. Schuijf et al.
Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography
Am Heart J
(2006)
A.S. Levey et al.
Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease
Am J Kidney Dis
(1998)
N.R. Mollet et al.
Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris
J Am Coll Cardiol
(2004)
J.D. Schuijf et al.
Noninvasive coronary imaging and assessment of left ventricular function using 16-slice computed tomography
Am J Cardiol
(2005)
J.J. Bax et al.
Which role for multislice computed tomography in clinical cardiology?
Am Heart J
(2005)
S. Achenbach et al.
Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT
Circulation
(2000)
Diagnosis and classification of diabetes mellitus
Diabetes Care
(2004)

There are more references available in the full text version of this article.

Cited by (18)

Prognostic value of cardiac computed tomography angiography: A systematic review and meta-analysis
2011, Journal of the American College of Cardiology
Citation Excerpt :
Use of annualized event rates was more homogeneous. Although the diagnostic accuracy of CCTA has been reported in >50 studies and meta-analyses (58,59), the prognostic value of CCTA for predicting clinical events is less defined. Our systematic review and meta-analysis is the first comprehensive analysis of multiple recent longitudinal studies describing the prognostic value of CCTA (7–25).
The purpose of this study was to systematically review and perform a meta-analysis of the ability of cardiac computed tomography angiography (CCTA) to predict future cardiovascular events and death.
The diagnostic accuracy of CCTA is well reported. The prognostic value of CCTA has been described in several studies, but many were underpowered. Pooling outcomes increases the power to predict rare events.
We searched multiple databases for longitudinal studies of CCTA with at least 3 months follow-up of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), consisting of death, myocardial infarction (MI), and revascularization. Annualized event rates were pooled using a bivariate mixed-effects binomial regression model to calculate summary likelihood ratios and receiver-operating characteristic curves.
Eighteen studies evaluated 9,592 patients with a median follow-up of 20 months. The pooled annualized event rate for obstructive (any vessel with >50% luminal stenosis) versus normal CCTA was 8.8% versus 0.17% per year for MACE (p < 0.05) and 3.2% versus 0.15% for death or MI (p < 0.05). The pooled negative likelihood ratio for MACE after normal CCTA findings was 0.008 (95% confidence interval [CI]: 0.0004 to 0.17, p < 0.001), the positive likelihood ratio was 1.70 (95% CI: 1.42 to 2.02, p < 0.001), sensitivity was 0.99 (95% CI: 0.93 to 1.00, p < 0.001), and specificity was 0.41 (95% CI: 0.31 to 0.52, p < 0.001). Stratifying by no CAD, nonobstructive CAD (worst stenosis <50%), or obstructive CAD, there were incrementally increasing adverse events.
Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.
Contributions of cardiac imaging techniques in the assessment of high cardiovascular risk patients
2009, Revista Clinica Espanola
La aterosclerosis es una enfermedad común y grave, sus complicaciones trombóticas causan la mayoría de las enfermedades mortales y discapacitantes. En el 30-50% de la población general, su primera manifestación clínica es el infarto de miocardio, que a menudo es fatal. Resulta inaceptable que con el arsenal terapéutico disponible actualmente, en la prevención primaria, el infarto de miocardio y la muerte súbita permanezcan con demasiada frecuencia como primeras manifestaciones de la aterosclerosis coronaria. Por lo tanto, la detección temprana de esta enfermedad puede proporcionar una gran oportunidad para prevenir muchos eventos cardiovasculares. Actualmente, disponemos de varias modalidades no invasivas de imagen que tienen el potencial para medir y monitorizar la aterosclerosis subclínica. Revisaremos en este capítulo las aportaciones en este sentido de la ecocardiografía, la tomografía por emisión de positrones, la tomografía computarizada para la detección de calcio coronario, la resonancia magnética y la ecografía carotídea.
Atherosclerosis is a common and dangerous disease, its thrombotic complications cause the majority of fatal and disabling diseases. In 30-50% of the general population, its first manifestation is myocardial infarction, which is often fatal. In the contemporary era of aggressive management of cardiovascular risk factors, it is unacceptable that myocardial infarction and sudden death remain highly common as first manifestation of coronary atherosclerosis. Therefore, early detection of this disease, may provide an important opportunity to prevent many cardiovascular events. Currently we have several non-invasive imaging modalities that have the potential to measure and monitor subclinical atherosclerosis. In the present article, the contributions of stress echocardiography, positron emission tomography, electron beam computed tomography, magnetic resonance coronary angiography and carotid ultrasonography, are reviewed.
Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: A systematic review
2008, International Journal of Cardiology
Multislice Spiral Computed Tomography (MSCT) is an emerging non-invasive diagnostic modality to detect coronary artery disease, which may alter diagnostic pathways and change the current clinical role of conventional coronary angiography.
To retrieve and critically assess information from the available literature on MSCT (≥ 16-slice) concerning its diagnostic accuracy, safety, applicability, clinical impact and cost-effectiveness.
Articles published between January 2002 and March 2007 were identified through searches of the Cochrane Library, MEDLINE, and other websites of manufacturers, cardiac professional societies, guidelines and abstracts from conference meetings.
We identified 1768 potentially relevant articles: 262 out of these were considered eligible for full evaluation and 150 were selected (57 assessed diagnostic accuracy, 130 applicability, 103 safety, 1 clinical impact and none cost-effectiveness).
The pre test probability of coronary artery disease was 56.7% (95% Confidence Interval: 55.1%–58.3%). A positive MSCT finding (pooled LR+: 5.4 (4.4–6.7)) increased the probability of CAD to 87.7% (84.3%–90.3%), whereas a negative MSCT result (pooled LR−: 0.09 (0.07–0.12)) reduced the probability of CAD to 10.7% (7.9%–14.4%).
MSCT is a promising technology for the assessment of coronary artery stenosis. However, the available literature is of limited value in providing guidance to support the development of policies for its appropriate utilization in clinical practice.
Coronary computed tomographic angiography: Competitive or complementary?
2006, Journal of Nuclear Cardiology
Anatomy and physiology in coronary artery disease imaging
2019, Journal of Nuclear Cardiology
Rationale and design of the measuring athlete’s risk of cardiovascular events (MARC) study: The role of coronary ct in the cardiovascular evaluation of middle-aged sportsmen
2015, Netherlands Heart Journal

View all citing articles on Scopus

: This work was financially supported by The Netherlands Heart Foundation, The Hague, The Netherlands (grants 2002B105 and 2001D032).

View full text

Original articleDo risk factors influence the diagnostic accuracy of noninvasive coronary angiography with multislice computed tomography?

Background

Methods and Results

Conclusion

Section snippets

Study Population

Clinical Features

Coronary Angiography in All Patients

Discussion

Acknowledgment

Lancet

Am Heart J

Am J Kidney Dis

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT

Circulation

Diagnosis and classification of diabetes mellitus

Diabetes Care

Original article
Do risk factors influence the diagnostic accuracy of noninvasive coronary angiography with multislice computed tomography?