Clinical Studies
Intravenous Electron-Beam Computed Tomographic Coronary Angiography for Segmental Analysis of Coronary Artery Stenoses

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Abstract

Objectives. We sought to identify and localize significant coronary stenoses on a segmental basis by electron-beam computed tomography (EBCT) and intravenous administration of a contrast agent.

Background. The clinical applicability and limitations of intravenous EBCT coronary angiography have not been defined.

Methods. EBCT was performed within 24 h of selective coronary angiography (SCA) in 28 patients (19 men and 9 women, mean [±SD] age 60 ± 10 years). After examination for coronary calcium, EBCT coronary angiography was performed using overlapping slices (in-plane resolution 0.34 to 0.41 mm) with a nominal slice thickness of 1 mm. Based on quantitative analysis of SCA, lumen diameter narrowing ≥50% (i.e., significant stenoses) was evaluated in 8 (major) or 12 (including side branches) coronary artery segments, using both two-dimensional (tomographic) and three-dimensional (volume) data sets.

Results. Of the 330 segments assessable by SCA, 237 (72%) were visualized by EBCT. The sensitivity (±SE) for detection of significant stenoses was 82 ± 6%; specificity was 88 ± 2%; positive and negative predictive values were 57 ± 7% and 96 ± 2%, respectively; and overall accuracy was 87 ± 2%. If only eight (major) coronary artery segments were considered, 194 (88%) of 221 segments were visualized, and the overall accuracy was 90 ± 2%. Seven (18%) of 38 significantly stenotic segments were classified as having <50% stenoses by EBCT. Six of these segments (86%), but only 9 (29%) of the 31 correctly classified stenotic segments, were severely calcified (area >20 mm2, p = 0.02). In 23 (12%) of 199 nonstenotic segments falsely classified as having ≥50% stenosis by EBCT, the lumen diameter was significantly smaller than that of the segments correctly classified as negative (mean [±SD] 1.5 ± 0.8 vs. 2.9 ± 1.1 mm, p < 0.001).

Conclusions. Intravenous EBCT coronary angiography allows for accurate segmental evaluation of significant disease in the major coronary arteries and may be of value for ruling out significant disease. The main determinant of false negative results is substantial segmental calcification, whereas the main determinant of false positive results is small vessel size.

Abbreviations

CI
confidence interval
EBCT
electron-beam computed tomography (tomographic)
ECG
electrocardiogram, electrocardiographic
LAD
left anterior descending coronary artery
LCx
left circumflex coronary artery
QCA
quantitative coronary angiography
RCA
right coronary artery
SCA
selective coronary angiography

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This study was funded by the Mayo Foundation (Grant 342-X-96), which also partly supported Dr. Rumberger. Dr. Schmermund was supported by a grant from the German Research Association (Deutsche Forschungsgemeinschaft, Schm 1233/1-1, Bonn) and a Heart Center Essen Cardiovascular Research Grant (Schm 97-1). Dr. Rensing was supported by a grant from the Dutch Interuniversity Cardiology Institute (ICIN), Utrecht, The Netherlands.