Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease

• Type: Article in International Scientific Journal
• Date: 2011

Authors

Bettencourt, N (Author) Other; Rocha, J (Author) Other; Ferreira, N (Author) Other; Pires Morais, G (Author) Other; Carvalho, M (Author) Other; Leite, D (Author) Other; Melica, B (Author) Other; Santos, L (Author) Other; Rodrigues, A (Author) Other; Braga, P (Author) Other; Teixeira, M (Author) Other; Simoes, L (Author) Other; Leite-Moreira AF (Author) FMUP; Cardoso, S (Author) Other; Nagel, E (Author) Other; Gama, V (Author) Other

Journal

Title: Journal of Cardiovascular Computed Tomography

Vol. 5

Pages: 392-405

ISSN: 1934-5925

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 29 Citations

Scopus - 26 Citations

Other information

Authenticus ID: P-002-KA5

DOI: 10.1016/j.jcct.2011.10.002

Abstract (EN): BACKGROUND: Preliminary studies have shown the potential of myocardial computed tomography perfusion (CTP) analysis for ischemia detection in both animals and humans. OBJECTIVE: To provide validation data on stress-rest CTP protocols as additive tools to improve the accuracy of multidetector computed tomography (MDCT) for coronary artery disease (CAD) in symptomatic patients. METHODS: Ninety symptomatic patients with suspected CAD (62 +/- 8 years, 66% males) underwent both MDCT and invasive coronary angiography (XA). The MDCT protocol included a prospective calcium score acquisition, a helical acquisition with retrospective gating during infusion of adenosine (140 mu g/kg/min) and a prospective scan for computed tomography angiography (CTA) at rest (total effective radiation dose: 5.1 +/- 0.8 mSv). Significant and higher-grade CADs were defined by the presence of >= 50% or >= 70% stenosis in at least one coronary artery, as evaluated by quantitative coronary angiography (QCA) using XA images. RESULTS: On a patient-based model, CTA sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) to detect >= 50% or >= 70% stenosis were 98%, 71%, 80%, and 97% (global accuracy 86%) and 100%, 60%, 64%, and 100% (accuracy 77%), respectively. An integrative approach of CTA and CTP results had the best performance for detection of CAD with sensitivity of 83%, specificity of 98%, PPV of 98%, and NPV of 84% (accuracy 84%) for detection of 50% stenosis and 97%, 90%, 88%, and 98% (accuracy 93%), respectively, for the 70% threshold. The integration of results had the best overall performance in all scenarios but was particularly advantageous in the prediction of higher-grade CAD, with an area under the curve of 0.93, compared with 0.80 for isolated CTA and 0.82 for CTP and in patients with severe calcifications (sensitivity 92%, specificity 87%, overall accuracy of 90%). CONCLUSIONS: The integration of functional and morphological data using CTA and CTP improved MDCT accuracy for detection of clinically relevant CAD at both thresholds of 50% and 70% in this intermediate to high pretest probability population.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 14