64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease

Meijboom, Willem B.; Mieghem, Carlos A.G. van; Mollet, Nico R.; Pugliese, Francesca; Weustink, Annick C.; Pelt, Niels van; Cademartiri, Filippo; Nieman, Koen; Boersma, Eric; Jaegere, Peter de; Krestin, Gabriël P.; Feyter, Pim J. de

doi:10.1016/j.jacc.2007.07.007

Cited by 328 publications

(170 citation statements)

References 10 publications

(5 reference statements)

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“…Nonetheless, diagnostic accuracy of CTCA has mainly been studied in patient populations with high prevalences of CAD (1-3,5,6,8,10), because ICA as the reference standard is only justifiable in populations with high risk for CAD. Only little data have been published on the topic (19), and our study is the first to use the recently suggested intention-to-diagnose strategy for evaluation (20), where nonevaluative segments in CTCA are rated as false-positive findings.…”

Section: Discussionmentioning

confidence: 97%

Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk

et al. 2008

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The institutional review board approved this study; written informed consent was obtained from all patients. Eighty-eight consecutive patients with suspected CAD (40 women; mean age, 64.3 +/-9.4 years; range, 39-82) underwent CTCA, calcium scoring, and invasive coronary angiography and were grouped according to their Framingham 10-year risk for hard coronary events into low (<10%), intermediate (10%-20%), and high (>20%) risk categories. Significant stenoses (luminal diameter narrowing > or =50%) were assessed on an intention-to-diagnose-basis; no coronary segment was excluded and nonevaluative segments were rated false positive. To determine differences between groups, Kruskal-Wallis tests were performed for individually determined values of diagnostic performance. RESULTS: Per-patient sensitivity, specificity, negative predictive, and positive predictive values were 90.0%, 79.2%, 95.0%, and 64.3%, respectively, with low (n = 34), 87.5%, 92.3%, 85.7%, and 93.3%, respectively, with intermediate (n = 29), and 100%, 75.0%, 100%, and 89.5%, respectively, with high risk (n = 25), with a trend toward higher positive predictive value (P = .07). Per-segment negative predictive value was lower with high pretest probability (P < .01). Mean calcium-score units were 90, 220, and 312 (P = .23), and the prevalence of CAD was 29.4%, 55.2%, and 68.0% (P < .01) with low, intermediate, and high risk. CONCLUSION: Sensitivity and specificity of CTCA are not influenced by the prevalence of CAD, whereas the negative predictive value is lower and the positive predictive value tends to be higher in patients with a high prevalence of CAD. were assessed on an intention-to-diagnose-basis; no coronary segment was excluded and nonevaluative segments were rated false positive. To determine differences between groups, Kruskal-Wallis tests were performed for individually determined values of diagnostic performance. Comparison of DiagnosticResults. Per-patient sensitivity, specificity, negative predictive, and positive predictive values were 90.0%, 79.2%, 95.0%, and 64.3%, respectively, with low (n ϭ 34), 87.5%, 92.3%, 85.7%, and 93.3%, respecitively, with intermediate (n ϭ 29), and 100%, 75.0%, 100%, and 89.5%, respectively, with high risk (n ϭ 25), with a trend toward higher positive predictive value (P ϭ .07). Per-segment negative predictive value was lower with high pretest probability (P Ͻ .01). Mean calciumscore units were 90, 220, and 312 (P ϭ .23), and the prevalence of CAD was 29.4%, 55.2%, and 68.0% (P Ͻ .01) with low, intermediate, and high risk.Conclusion. Sensitivity and specificity of CTCA are not influenced by the prevalence of CAD, whereas the negative predictive value is lower and the positive predictive value tends to be higher in patients with a high prevalence of CAD. Original InvestigationsSixty-four-slice computed tomography (CT) has been shown to be a reliable noninvasive tool to document or rule out significant coronary artery lesions (1-10). In particular, the high negative predictive value (NPV) of CT coronary angiog...

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Section: Discussionmentioning

confidence: 97%

Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk

et al. 2008

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“…The main field of employment for cardiac MDCT is coronary angiography of patients with low or medium pre-test probability of coronary artery disease [34]. Hence, the number of patients with poor cardiac function should be significantly small.…”

Section: Automatic Vs Semi-automatic Global Cardiac Function Assessmentmentioning

confidence: 99%

Automaticvssemi-automatic global cardiac function assessment using 64-row CT

Greupner

Zimmermann²,

Hamm³

et al. 2012

BJR

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Objective: Global cardiac function assessment using multidetector CT (MDCT) is timeconsuming. Therefore we sought to compare an automatic software tool with an established semi-automatic method. Methods: A total of 36 patients underwent CT with 6460.5 mm detector collimation, and global left ventricular function was subsequently assessed by two independent blinded readers using both an automatic region-growing-based software tool (with and without manual adjustment) and an established semi-automatic software tool. We also analysed automatic motion mapping to identify end-systole. Results: The time needed for assessment using the semi-automatic approach (12:12¡6:19 min) was reduced by 75-85% with the automatic software tool (unadjusted, 01:34¡0:29 min, adjusted, 02:53¡1:19 min; both p,0.001). There was good correlation (r50.89; p,0.001) for the ejection fraction (EF) between the adjusted automatic (58.6¡14.9%) and the semi-automatic (58.0¡15.3%) approaches. Also the manually adjusted automatic approach led to significantly smaller limits of agreement than the unadjusted automatic approach for end-diastolic volume (¡36.4 ml vs ¡58.5 ml, p.0.05). Using motion mapping to automatically identify end-systole reduced analysis time by 95% compared with the semi-automatic approach, but showed inferior precision for EF and end-systolic volume. Conclusion: Automatic function assessment using MDCT with manual adjustment shows good agreement with an established semi-automatic approach, while reducing the analysis by 75% to less than 3 min. This suggests that automatic CT function assessment with manual correction may be used for fast, comfortable and reliable evaluation of global left ventricular function.

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“…According to Bayes' theorem, patients with an intermediate pretest probability for a disease or condition are likely to benefit the most from diagnostic investigations (3). The use of cardiac CT and CT coronary angiography (CTA) for the exclusion of obstructive CAD (greater than 50% diameter stenosis) is therefore best applied in symptomatic patients with an intermediate pretest probability for CAD.…”

Section: Symptomatic Patientsmentioning

confidence: 99%

The ‘what, when, where, who and how?’ of cardiac computed tomography in 2009: Guidelines for the clinician

Chow

Larose

Bilodeau

et al. 2009

Canadian Journal of Cardiology

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64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease

Cited by 328 publications

References 10 publications

Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk

Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk

Automaticvssemi-automatic global cardiac function assessment using 64-row CT

The ‘what, when, where, who and how?’ of cardiac computed tomography in 2009: Guidelines for the clinician

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