RT Journal Article
SR Electronic
T1 Combining dual-source computed tomography coronary angiography and calcium scoring: added value for the assessment of coronary artery disease
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1154
OP 1161
DO 10.1136/hrt.2007.124800
VO 94
IS 9
A1 S Leschka
A1 H Scheffel
A1 L Desbiolles
A1 A Plass
A1 O Gaemperli
A1 P Stolzmann
A1 M Genoni
A1 T Luescher
A1 B Marincek
A1 P Kaufmann
A1 H Alkadhi
YR 2008
UL http://heart.bmj.com/content/94/9/1154.abstract
AB Objective: To prospectively investigate the diagnostic accuracy of dual-source 64-slice computed tomography coronary angiography (CTCA), calcium scoring (CS) and both methods combined for assessing significant coronary artery stenoses relative to conventional coronary angiography (CCA).Design, setting and patients: Prospective, single-centre study conducted in a referral centre enrolling 74 consecutive patients (24 women; mean age 62 (SD 12) years) from August-October 2006. All study participants underwent CS, CTCA and CCA. Diagnostic accuracy was calculated for CS, CTCA and both methods combined relative to CCA. Not-evaluative segments at computed tomography were considered false positive.Results: CCA identified 139 stenoses in 36 patients. Average heart rate during CTCA was 68 (13) bpm (range 35–102 bpm), and 2% of segments (21/1001) in 11% of patients (8/74) were not evaluative. Considering these as false positives, per-patient sensitivity and specificity was 98% and 87%. When using CS cut-off values of 0 to exclude and ⩾400 to predict stenosis, sensitivity and specificity of CS was 100% and 70%, respectively. Combining CS and CTCA in all patients correctly reclassified five patients, while six were falsely classified as stenotic, all of them correctly classified with CTCA alone. Using CS only in patients with not-evaluative segments correctly reclassified five patients while avoiding misclassifications (sensitivity 98%, specificity 100%).Conclusion: Dual-source CTCA allows the diagnosis of significant stenoses with a high diagnostic accuracy. Selectively combining CS with CTCA in patients with not-evaluative coronary segments improves specificity from 87% to 100% without decreasing the high sensitivity of 98%.