Feasibility and diagnostic accuracy of 16-slice multidetector computed tomography coronary angiography in 500 consecutive patients: critical role of heart rate
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To evaluate the feasibility and diagnostic accuracy of multidetector computed tomography coronary (MDCT) angiography applied to an unselected heart-disease population, to identify all causes of unfeasibility of exams, the distribution of artifacts in every coronary segment and their influence on diagnostic accuracy of examination.
Materials and methods
We evaluated 500 patients with different indications for invasive coronary angiography. All underwent coronary MDCT and ICA. 215 patients were pre-treated with metoprolol intravenously. In the whole population we studied native coronary arteries and in 141 cases the patency of coronary artery bypass grafts (CABG). The quality of MDCT images was graded as good, sufficient and insufficient.
We were able to evaluate the patency of all grafts, with the exception of 4 cases. Diagnostic accuracy of CABG evaluation was very high (sensitivity 100%, specificity 98.4%). In native coronary arteries the overall feasibility was 97.9%. The middle left circumflex artery, right coronary artery and posterior descending artery were the segments most often poorly visualized. The first cause of artifacts was misalignment related to high heart rate, followed by premature heart beats and calcified plaque. The population was separated into 3 groups: group 1: heart rate <55 bpm, group 2: 55–65 bpm, group 3: >65 bpm. In group 1, misalignment was significantly lower than in groups 2 and 3. On a segment-based analysis, overall feasibility was therefore significantly higher in group 1 vs group 2 and vs group 3. Images of good quality were significantly higher in group 1 (95.4%) than in group 2 (87%) and group 3 (71.8%). The higher image quality in group 1 impacts on the overall diagnostic accuracy of the exam. Indeed overall sensitivity is significantly higher in group 1 (89.5%) than in group 2 (86%) and group 3 (82.8%) and overall specificity is significantly higher in group 1 than in group 3.
Multidetector computed tomography has a high feasibility and diagnostic accuracy for the evaluation of coronary artery disease in an unselected population. Good patient preparation (optimized beta-blocker therapy, correct breathing instructions) is essential for evaluating native coronary arteries while preparation with a beta-blocker is less relevant in bypass graft patients.
KeywordsBeta-blocker therapy Heart rate Misalignment of slices
American heart association
Coronary artery disease
First diagonal branch
Second diagonal branch
Invasive coronary angiography
Internal mammary artery
Left anterior descending artery
Left circumflex artery
Left main artery
First marginal branch
Second marginal branch
Multidetector computed tomography
Negative predictive value
Posterior descending artery
Positive predictive value
Right coronary artery
- 1.Scanlon P, Faxon D, Audet A et al (1999) Society for Cardiac Angiography and Interventions. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). J Am Coll Cardiol 33:1756–1824PubMedCrossRefGoogle Scholar
- 2.Bashore TM, Bates ER, Berger PB et al (2001) American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:2170–2214PubMedCrossRefGoogle Scholar
- 12.Cademartiri F, Marano R, Luccichenti G et al (2004) Anatomia normale del circolo coronarico con tomografia computerizzata multistrato a 16 canali. Radiol Med 107:11–23Google Scholar
- 15.Kopp AF, Schroeder S, Kuettner A et al (2002) Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients European Heart Journal 23:1714–1725Google Scholar
- 19.Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for grading of coronary artery disease, Council of Cardiovascular Surgery, American Heart Association. Circulation 51:35–40Google Scholar
- 23.Sung SS, Yookyung K, Soo Mee L (2005) Improvement of image quality with beta-blocker premedication on ECG-gated 16-MDCT coronary angiography. AJR 84:649–654Google Scholar
- 32.Marano R, Storto ML, Maddestra N et al (2004) Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography. Eur J Radiol 14:1353–1362Google Scholar
- 34.Hendel RC, Patel MR, Kramer CM, Poon M et al (2006) American College of cardiology foundation quality strategic directions committee appropriateness criteria working group; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48(7):1475–1497Google Scholar