CAD Detection in Patients With Intermediate-High Pre-Test Probability Low-Dose CT Delayed Enhancement Detects Ischemic Myocardial Scar With Moderate Accuracy But Does Not Improve Performance of a Stress-Rest CT Perfusion Protocol

• Type: Article in International Scientific Journal
• Date: 2013

Authors

Bettencourt, N (Author) Other; Ferreira, ND (Author) Other; Leite, D (Author) Other; Carvalho, M (Author) Other; Ferreira, WD (Author) Other; Schuster, A (Author) Other; Chiribiri, A (Author) Other; Leite-Moreira AF (Author) FMUP; Silva Cardoso, J (Author) FMUP; Nagel, E (Author) Other; Gama, V (Author) Other

Journal

Title: JACC: Cardiovascular Imaging

Vol. 6

Pages: 1062-1071

ISSN: 1936-878X

Publisher: JACC: American College of Cardiology

Indexing

ISI Web of Knowledge - 44 Citations

Scopus - 46 Citations

Other information

Authenticus ID: P-008-FCD

DOI: 10.1016/j.jcmg.2013.04.013

Abstract (EN): OBJECTIVES This study sought to compare computed tomography delayed enhancement (CTDE) against cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) for detection of ischemic scar and to test the additive value of CIDE as part of a comprehensive multidetector computed tomography (MDCT) stress rest protocol including computed tomography perfusion (CTP) and computed tomography angiography (CTA) for the diagnosis of significant coronary artery disease (CAD). BACKGROUND CTDE has been recently described as a promising tool for noninvasive detection of myocardial scar, similarly to CMR-LGE techniques. Despite its theoretical potential as an adjunctive tool to improve MDCT accuracy for detection of CAD, its clinical performance has not been validated. METHODS One hundred five symptomatic patients with suspected CAD (age 62.0 +/- 8.0 years, 67% men) underwent MDCT, CMR, and x-ray invasive coronary angiography. The MDCT protocol consisted of calcium scoring, stress CTP under adenosine 140 mu g/kg/min, rest CTP + CTA, and a low-dose radiation prospective scan for detection of CTDE. CMR-LGE was used as the reference standard for assessment of scar. Functionally significant CAD was defined as the presence of >= 90% stenosis/occlusion or fractional flow reserve measurements <= 0.80 in vessels >2 mm. RESULTS CTDE had good accuracy (90%) for ischemic scar detection with low sensitivity (53%) but excellent specificity (98%). Positive and negative predictive values were 82% and 91%, respectively. On a patient-based model, MDCT protocol without integration of CTDE results had a sensitivity, specificity, and positive and negative predictive values of 90%, 81%, 80%, and 90%, respectively, for the detection of functionally significant CAD. Addition of CTDE results did not improve MDCT performance (90%, 77%, 77%, and 90%, respectively). CONCLUSIONS CTDE has moderate accuracy for detection of ischemic scar in patients with suspected CAD. Integration of CTDE into a comprehensive MDCT protocol including stress rest CTP and CIA does not improve MDCT accuracy for detection of significant CAD in intermediate-to-high pretest probability populations. (C) 2013 by the American College of Cardiology Foundation

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 10