Comparison of visibility and diagnostic capability of noninvasive coronary angiography by eight-slice multidetector-row computed tomography versus conventional coronary angiography

Maruyama, Takao; Yoshizumi, Tohru; Tamura, Ritsu; Takashima, Shigekazu; Toyoshima, Hiroyuki; Konishi, Ichiro; Yamashita, Shizuya; Yamasaki, Koreyoshi

doi:10.1016/j.amjcard.2003.11.014

Cited by 35 publications

(16 citation statements)

References 17 publications

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“…Still, our results are very similar to those obtained in the few available comparisons between MSCT and MRI (13,14). Third, in the present study, 14% of coronary segments were uninterpretable, which is in line with previous studies (6,11,22). However, with the introduction of 32-and 64-slice systems, the percentage of uninterpretable segments is likely to decline further.…”

Section: Left Ventricular Functionsupporting

confidence: 92%

Noninvasive Angiography and Assessment of Left Ventricular Function Using Multislice Computed Tomography in Patients With Type 2 Diabetes

et al. 2004

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OBJECTIVE -Early identification of coronary artery disease (CAD) in patients with diabetes is important because these patients are at increased risk for CAD and have worse outcome than nondiabetic patients after CAD is diagnosed. Recently, noninvasive coronary angiography and assessment of left ventricular function has been demonstrated with multislice computed tomography (MSCT). The purpose of the present study was to validate this approach in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -MSCT was performed in 30 patients with confirmed type 2 diabetes. From the MSCT images, coronary artery stenoses (Ն50% luminal narrowing) and left ventricular function (left ventricular ejection fraction, regional wall motion) were evaluated and compared with results of conventional angiography and two-dimensional echocardiography.RESULTS -Two hundred twenty of 256 coronary artery segments (86%) were interpretable with MSCT. In these segments, sensitivity and specificity for detection of coronary artery stenoses were 95%. Including the uninterpretable segments, sensitivity and specificity were 81 and 82%, respectively. Bland-Altman analysis in the comparison of left ventricular ejection fractions demonstrated a mean difference of Ϫ0.48 Ϯ 3.8% for MSCT and echocardiography, which was not significantly different from 0. Agreement between the two modalities for assessment of regional contractile function was excellent (91%, statistic 0.81).CONCLUSIONS -Accurate noninvasive evaluation of both the coronary arteries and left ventricular function with MSCT is feasible in patients with type 2 diabetes. This noninvasive approach may allow optimal identification of high-risk patients. Diabetes Care 27:2905-2910, 2004T ype 2 diabetes is a major risk factor for coronary artery disease (CAD) and is associated with a two-to fourfold increase in the risk of CAD (1). Furthermore, prognosis of patients with type 2 diabetes and confirmed CAD has been demonstrated to be worse than in nondiabetic patients with CAD. For example, the likelihood of developing myocardial infarction is significantly higher in diabetic patients with unstable angina than in nondiabetic individuals. Moreover, mortality rate after myocardial infarction has also been shown to be doubled (2). Early identification of CAD is, therefore, of paramount importance in patients with diabetes.Noninvasive testing including myocardial perfusion scintigraphy and dobutamine stress echocardiography have been used to detect CAD (3,4). However, direct visualization of the coronary arteries may be preferred because patients with diabetes frequently have diffuse, multivessel CAD. Currently, conventional angiography is performed to evaluate the presence and extent of CAD. However, this is an invasive approach associated with a minimal but definitive risk of complications, and a noninvasive technique that is capable of direct visualization of the coronary arteries would be preferred. A promising new imaging technique for the noninvasive detection of CAD is multislice computed tomo...

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Section: Left Ventricular Functionsupporting

confidence: 92%

Noninvasive Angiography and Assessment of Left Ventricular Function Using Multislice Computed Tomography in Patients With Type 2 Diabetes

et al. 2004

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“…Similar percentages have been reported previously. 13,19,27 In the near future, however, this limitation may be overcome by the introduction of 32-detector and 64-detector row scanners in combination with faster rotation times, which are likely to reduce the percentage of nonassessable segments. Second, an important drawback of MSCT is the radiation dose that is still considerably high: Ϸ8 mSv.…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

Noninvasive Evaluation of the Coronary Arteries With Multislice Computed Tomography in Hypertensive Patients

et al. 2005

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Abstract-Because patients with hypertension are at increased risk for coronary artery disease, early and noninvasive identification of the disease in patients with hypertension is important. Recently, multislice computed tomography (MSCT) has been demonstrated to allow both noninvasive coronary angiography and assessment of left ventricular function. The purpose of the present study therefore was to demonstrate the feasibility of this approach in patients with hypertension with known or suspected coronary artery disease and to compare the results to invasive coronary angiography and 2-dimensional echocardiography, respectively. MSCT was performed in 31 patients with confirmed hypertension. From the MSCT images, the presence of significant coronary stenoses (Ն50% luminal narrowing) and regional wall motion abnormalities were evaluated and compared with invasive coronary angiography and 2-dimensional echocardiography. In addition, left ventricular ejection fraction was calculated from the MSCT images. A total of 243 (88%) coronary artery segments could be evaluated with MSCT. Sensitivity and specificity for the detection of significant coronary artery stenoses were 93% and 96%. On a per-patient basis, MSCT was accurate in 28 (90%) patients. Mean left ventricular ejection fraction was 46Ϯ14% (range, 16% to 64%). The agreement for assessing regional wall motion was 91% (kappa statistic, 0.81). Key Words: coronary artery disease Ⅲ imaging C oronary artery disease (CAD) is the major cause of morbidity and mortality in hypertensive patients, especially because patients with hypertension are at increased risk for CAD as compared with normotensive individuals. 1,2 Moreover, because hypertension is present in 1 of every 5 adults, noninvasive detection of CAD in this particular patient group has become a clinically important issue. 3 However, of several noninvasive tests, including exercise electrocardiography and myocardial perfusion imaging, a limited specificity in hypertensive patients has been reported because of an increased occurrence of false-positive results in this particular patient group. 4 -7 These positive test results may represent impaired vasodilator reserve and increased myocardial oxygen demand as a consequence of microvascular disease, and thus myocardial ischemia in the absence of significant coronary artery abnormalities. 4 -9 A noninvasive test therefore should ideally allow direct visualization of the coronary arteries to detect or exclude obstructive CAD to triage patients for optimal medical therapy or invasive evaluation.Over recent years, multislice computed tomography (MSCT) has emerged as a potential noninvasive imaging method that allows the acquisition of high-quality images of the entire heart within a single breath-hold. High sensitivities and specificities in the detection of coronary artery stenoses have been reported, ranging from 72% to 95% and 75% to 99%, respectively. 10 -19 Furthermore, the simultaneous recording of the electrocardiogram permits the reconstruction of images at any...

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“…[26][27][28] Recent reports have suggested that CTA with MDCT in the field of cardiology exhibits sufficiently high diagnostic capability compared with conventional angiography. 29,30 Therefore, CTA may be a helpful diagnostic tool in the field of rheumatology, such as in the diagnosis of vasculitic syndromes.…”

Section: Discussionmentioning

confidence: 99%

HLA-B52-positive vasculo-Beh�et disease: usefulness of magnetic resonance angiography, ultrasound study, and computed tomographic angiography for the early evaluation of multiarterial lesions

et al. 2005

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We report a case of HLA-B52-positive Behçet disease accompanied by multiarterial lesions. A 24-year-old woman was suffering from sporadic high fever and recurrent oral and genital ulcers, and laboratory data revealed severe inflammation. A diagnosis of Behçet disease was made. Magnetic resonance angiography, ultrasound study, and computed tomographic angiography demonstrated multiarterial lesions that had caused no symptoms. These noninvasive examinations were extremely useful in evaluating asymptomatic early vascular lesions.

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Comparison of visibility and diagnostic capability of noninvasive coronary angiography by eight-slice multidetector-row computed tomography versus conventional coronary angiography

Cited by 35 publications

References 17 publications

Noninvasive Angiography and Assessment of Left Ventricular Function Using Multislice Computed Tomography in Patients With Type 2 Diabetes

Noninvasive Angiography and Assessment of Left Ventricular Function Using Multislice Computed Tomography in Patients With Type 2 Diabetes

Noninvasive Evaluation of the Coronary Arteries With Multislice Computed Tomography in Hypertensive Patients

HLA-B52-positive vasculo-Beh�et disease: usefulness of magnetic resonance angiography, ultrasound study, and computed tomographic angiography for the early evaluation of multiarterial lesions

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