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

Abstract

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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