Clinical studies
Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease

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Abstract

OBJECTIVES

This study compared coronary artery calcium (CC) as detected by electron beam computed tomography (EBCT) with conventional stress testing in the evaluation of patients with symptoms suggestive of coronary artery disease (CAD).

BACKGROUND

Exercise electrocardiogram treadmill stress testing (treadmill-ECG) is limited by its requirement of a normal resting ECG and the ability of the patient to exercise adequately. The addition of myocardial imaging agents such as technetium improves the sensitivity and specificity but substantially increases the cost and prolongs the testing time. The use of EBCT provides a noninvasive and rapid method for identifying the presence and amount of CC, which has been shown to be related to atherosclerosis, and may provide additional information in combination with more traditional noninvasive testing methods.

METHODS

A total of 97 patients underwent technetium stress testing (technetium-stress), treadmill-ECG, and EBCT coronary scanning within three months of coronary angiography for the evaluation of chest pain.

RESULTS

The relative risk (RR) of obstructive angiographic CAD for an abnormal test was higher for EBCT (4.53) than either treadmill-ECG (1.72) or technetium-stress (1.96). The low specificity of EBCT (47%) was improved by the addition of treadmill-ECG (83%, p < 0.05).

CONCLUSIONS

Electron beam computed tomography has a higher diagnostic ability than either treadmill-ECG or technetium-stress for the detection of obstructive angiographic CAD. Electron beam computed tomography is an accurate and noninvasive alternative to traditional stress testing for the detection of obstructive CAD in symptomatic patients.

Abbreviations

CAD
coronary artery disease
CC
coronary artery calcification
EBCT
electron beam computed tomography
HU
Hounsfield unit
MIBI
methoxyisobutylisonitrile
NPV
negative predictive value
PPV
positive predictive value
ROC
receiver operating characteristic
technetium-stress
technetium stress testing
treadmill-ECG
exercise electrocardiogram treadmill stress testing

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