Rationale and Objectives
Endowed with sufficient diagnostic accuracy, electron beam computed tomography angiography (CTA) is being increasingly used to evaluate coronary arteries. However, data on direct comparisons with nuclear myocardial perfusion studies are limited. In this study, we sought to compare the accuracies of CTA and myocardial perfusion imaging (MPI) for identifying symptomatic patients with hemodynamically significant obstructive coronary artery disease (CAD).
Materials and Methods
In a single-center study, symptomatic outpatients who were scheduled for cardiac catheterization were prospectively enrolled. Only patients with exertional angina or dyspnea were included. After fulfilling the inclusion criteria, 30 patients were enrolled in the study (mean age 54 ± 9 years and 70% males). Patients underwent MPI, CTA including coronary artery calcification (CAC) measure, and invasive coronary angiography for evaluation of obstructive coronary artery disease. Significant CAD was defined as >50% left main artery stenosis or >70% stenosis of any other epicardial vessel by invasive angiography. The sensitivities, specificities and predictive values of MPI, CAC, and CTA were analyzed per patient
Results
CTA demonstrated significant higher sensitivity than MPI (95% vs. 81%, P < .05). CTA demonstrated significantly higher specificity than both MPI (89% versus 78%, P = .04) and CAC (56%, P = .002). CTA also performed better in a per-vessel analysis (sensitivity 94%, specificity 96%) than both nuclear and CAC. There were no significant differences between the sensitivities and specificities of MPI and CAC.
Conclusion
CTA accurately detects obstructive CAD in symptomatic patients and may be more accurate than MPI or CAC assessment. Larger studies in a more diverse population are needed.
The cost and the risk of invasive angiography have encouraged the development of new diagnostic methods that allow the coronary arteries to be visualized noninvasively. The last decade has seen great strides in the field of cardiac imaging, particularly in the ability of cardiac computed tomographic angiography (CTA) to visualize the coronary lumen with sufficient diagnostic accuracy ( ). Being such a modality, CTA is now being increasingly used in clinical practice. As a result of having high spatial and improved temporal resolution, this imaging modality not only allows branches of the coronary artery to be evaluated, but also allows simultaneous analysis of other cardiac structures, making it extremely useful for other cardiac applications ( ). Moreover, coronary artery calcium (CAC) detected by computed tomography has been shown to be highly specific for atherosclerosis and has prognostic value, yielding valuable information for risk stratification, being both incremental and independent to traditional risk factors ( ).
Other utility has been demonstrated with this modality, including calculation of ejection fraction, as well as assessment of global and regional wall motion evaluation ( ). CTA has been shown to be accurate for determining the presence and severity of coronary artery disease (CAD) ( ).
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Methods
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Angiography Protocol
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CTA Protocol
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Statistical Methods
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Results
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Table 1
Table Showing the Comparison Between Computed Tomography Angiography and Myocardial Perfusion Imaging
Imaging Modality Coronary Artery Calcium Nuclear Myocardial Perfusion Imaging Cardiac Computed Tomography Angiography Sensitivity 90 81 94 Specificity 56 78 96 Positive predictive value 83 89 92 Negative predictive value 71 64 97
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Discussion
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Limitations
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