Prognostic Value of CT Angiography in Patients With Inconclusive Functional Stress Tests

Azevedo, Clerio F.; Hadlich, Marcelo; Bezerra, Sabrina; Petriz, Joao; Alves, Rogério Rufino; Souza, Olga; Rati, M; Albuquerque, Denílson Campos de; Moll, Jorge

doi:10.1016/j.jcmg.2011.02.017

Cited by 38 publications

(26 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A timely diagnosis with coronary artery disease (CAD) is imperative in light of the morbidity and mortality of that concerns the disease (1). Invasive coronary angiography (ICA) is the gold standard for identifying coronary artery stenosis; however, it is an invasive process with very high radiation exposure (2).…”

mentioning

confidence: 99%

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality

Selcuk

Otcu

Yüceler³

et al. 2016

Balkan Med J

View full text Add to dashboard Cite

Background: Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. Aims: In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. Study Design: Retrospective cross-sectional study. Methods: Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts-4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. Results: Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. Conclusion: CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates. Keywords: Computed tomography angiography, coronary arteries, high-pitch, low radiation dose, heart rate Copyright 2016 © Trakya University Faculty of Medicine Balkan Med J 201633: 283-93 Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality

show abstract

mentioning

confidence: 99%

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality

Selcuk

Otcu

Yüceler³

et al. 2016

Balkan Med J

View full text Add to dashboard Cite

show abstract

“…Regarding cardiac CT, a recent series of studies have shown that, not only the CACS assessment, but also the assessment of coronary anatomy by use of CCTA provide important prognostic information in patients suspected of having significant CAD 42,44,45,[47][48][49] . Using a 16-row detector CT device, Min et al 44 have studied 1,127 patients and assessed the relationship between all-cause mortality and the results of CCTA.…”

Section: Prognostic Valuementioning

confidence: 99%

“…In a recent study, Azevedo et al 48 have assessed 529 patients suspected of having obstructive CAD, who had undergone ischemia tests with inconclusive results. Those authors have shown that 70% of those patients had no significant obstructive lesion.…”

Section: Prognostic Valuementioning

confidence: 99%

Escore de cálcio e angiotomografia coronariana na estratificação do risco cardiovascular

Azevedo¹,

Rochitte²,

Lima

2012

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Cardiovascular disease is the leading mortality cause worldwide. The capacity to identify among the asymptomatic individuals the subgroup at greater risk for developing cardiovascular events is fundamental in any strategy aimed at reducing the rate of cardiovascular events. The first step in cardiovascular risk stratification is the use of global risk scores, the Framingham risk score being the most frequently used. However, previous studies have shown that, although very useful, clinical scores, when used alone, have a limited capacity for stratifying cardiovascular risk in a significant part of the population.In that context, coronary artery calcium score (CACS) and coronary computed tomographic angiography might play an important role as complementary tools for risk stratification of asymptomatic patients. The CACS provides important prognostic information that is incremental to clinical scores based on traditional risk factors and other diagnostic modalities, such as C-reactive protein measurement. In addition, CACS has the potential to change and help the patients' clinical management. On the other hand, coronary computed tomographic angiography provides a detailed assessment of the anatomy of the coronary arteries, allowing visualizing not only the lumen, but also the coronary arterial walls. Compared with conventional invasive coronary angiography, coronary computed tomographic angiography has excellent accuracy to identify and mainly exclude the presence of significant obstructive lesions. In addition, it proved to be able to provide incremental prognostic information to traditional risk factors and CACS.

show abstract

“…The recent technical development of multi-detector computed tomography (MDCT) has rendered it feasible to calculate CACS and to detect coronary artery plaque or obstructive coronary lesions using CT coronary angiography (CT CA). The presence of obstructive coronary lesions, noncalcified coronary plaque (NCP) or the number of coronary plaques detected by CTCA improves the prediction of cardiac events over and above conventional risk scores and CACS [3][4][5][6]. Moreover, NCP with both a low CT value and positive remodeling is associated with the subsequent development of acute coronary syndrome (ACS) [7].…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Noda¹,

Matsutera²,

Yasuoka³

et al. 2013

ACT

View full text Add to dashboard Cite

Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 -1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 -9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 -9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 -1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 -25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.

show abstract

Prognostic Value of CT Angiography in Patients With Inconclusive Functional Stress Tests

Abstract: Among patients with inconclusive functional stress tests, the noninvasive assessment of CAD severity by coronary CTA has been shown to provide incremental prognostic information beyond the evaluation of traditional risk factors and coronary artery calcium score.

Cited by 38 publications

References 20 publications

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality

Escore de cálcio e angiotomografia coronariana na estratificação do risco cardiovascular

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Contact Info

Product

Resources

About