2011, Number 1
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Rev Invest Clin 2011; 63 (1)
Diagnostic validity of coronary angiotomography
Rodríguez-Caravaca G, Robles-Velasco P, Olmedilla-Arregui P, Hernández-Muñíz S, Sanz-Mayordomo P, Trapero-García MÁ
Language: Spanish
References: 23
Page: 18-24
PDF size: 63.01 Kb.
ABSTRACT
Background. Coronary arterial disease is the main cause of
morbidity in western countries and coronary angiography is
the most important diagnosis test. Lately, coronary angiotomography
has been introduced for studying coronary arteries
in a non-invasive way. Our goal was to assess the diagnostic
accuracy of coronary angiotomography in the diagnosis of
coronary arterial disease.
Material and methods.Crosssectional
study for assessing diagnostic test comparing coronary
angiotomography to invasive angiography in patients
without previous coronary disease. All the patients underwent
both tests consecutively in a blind way. Coronary arteries
were studied according to the modified reference model of
coronary segmentary analysis of the American Heart Association.
Tomography validity indexes (sensitivity, specificity,
positive –PPV- and negative –NPV- predictive values and
global value) by patient, artery, and segment were calculated.
Results. We studied 121 patients (47 females -38.8%- and
74 males -61.2%-). Prevalence of coronary arterial disease was
38%. The most frequent risk factor detected was hypertension.
We obtained a 100% sensitivity and NPV studying
patients as a whole by patient, a specificity of 92% (95% CI:
86.0-99.0) and a global value of 94% (95% CI: 89.0-99.0). The
higher validity by artery was for anterior descending artery
with a specificity of 98% (CI95%: 90.0-96.0) and NPV of 97%
(IC95%: 96.0-100). The segment with higher validity was distal
right coronary artery with 100% specificity and PPV.
Conclusion. A high diagnostic validity of coronary angiotomography
was obtained and it could be considered as another
diagnostic test for styding coronary arterial disease.
REFERENCES
American Heart Association, American stroke association. 2002 heart and stroke statistical update. Dallas, TX: the american heart association, 2002.
Marrugat J, Sala J, Aboal J. Epidemiología de las enfermedades cardiovasculares en la mujer. Rev Esp Cardiol 2006; 59: 264.
Bashore TM, Bates ER, Berger PB, Clark DA, Cusma JT, Dehmer GJ, et al. 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 2001; 37: 2170-214.
ACC/AHA Guidelines for Coronary Angiography A Report of the American College of Cardiology. J Am Coll Cardiol 1999; 33: 1756-1824.
Mollet NR, Cademartiri F, Nieman K, Saia F, Lemos PA, McFadden EP, et al. Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol 2004; 43: 2265-70.
Hoffmann MHK, Shi H, Schmitz BL, Schmid FT, Lieberknecht M, Schulze R, et al. Noninvasive coronary angiography with multislice computed tomography. JAMA 2005; 293: 2471-8.
Pannu H, Flohr T, Corl F, Fishman EK. Current Concepts in Multi-Detector Row CT Evaluation of the Coronary Arteries: Priciples, Techniques, and Anatomy. Radiographics 2003; 23: 111-25.
Giesler T, Baum U, Ropers D, Ulzheimer S, Wenkel E, Mennicke M, et al. Noninvasive visualization of coronary arteries using contrast enhanced multidetector CT: influence of heart rate in image quality and stenosis detection. AJR Am J Roentgenol 2002; 179: 911-16.
Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ. Reliable noninvasive coronary angiography with fast submillimiter multislice spiral computed tomography. Circulation 2002; 106: 2051-4.
Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, et al. Detection of Coronary Artery stenosis with thin slice Multidetector Row Spiral Computed Tomography and Multiplanar Reconstruction. Circulation 2003; 107: 664-6.
Gopalakrishnan P, Wilson GT, Tak T. Accuracy of multislice computed tomography coronary angiography: a pooled estimate. Cardiol Rev 2008; 16: 189-96.
Sun Z, Lin C, Davidson R, Dong C, Liao Y. Diagnostic value of 64-slice CT angiography in coronary artery disease: a systematic review. Eur J Radiol 2008; 67: 78-84.
Leta R, Carreras F, Alomar X, Monell J, García-Picart J, Augé JM, et al. Non-invasive coronary angiography with 16 multidetector- row spiral computed tomography: a comparative study with invasive coronary angiography. Rev Esp Cardiol 2004; 57: 217-24.
Pundziute G, Schuijf JD, Jukema JW, Lamb HJ, de Roos A, van der Wall EE, et al. Impact of coronary calcium score on diagnostic accuracy of multislice computed tomography coronary angiography for detection of coronary artery disease. J Nucl Cardiol 2007; 14: 36-43.
Schuijf JD, Bax JJ, Shaw LJ, de Roos A, Lamb HJ, van der Wall, et al. Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multi-slice computed tomography for non-invasive coronary angiography. Am Heart J 2006; 151: 404-11.
Hoffmann U, Mosoelewski F, Cury RC, Ferencik M, Jang IK, Diaz LJ, et al. Pedictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient-versus segment-based analysis. Circulation 2004; 110: 2638-43.
Kuettner A, Kopp AF, Schroeder S, Reiger T, Brunn J, Meisner C, et al. Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 2004; 43: 831-9.
Mollet NR, Cademartiri F, van Mieghem CA, Runza G, McFadden EP, Baks T, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 2005; 112: 2318-23.
Obuchowski NA. ROC analysis. AJR Am J Roentgenol 2005; 184: 364-72.
Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, et al. Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. J Am Coll Cardiol 2005; 45: 123-7.
Paré-Bardera JC, Aguilar-Torres R, Gallego García de Vinuesa P, Velasco del Castillo S. Actualización en técnicas de imagen cardiaca. Ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores. Rev Esp Cardiol 2007; 60: 41-57.
van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 2009; 53: 623-32.
Redberg RF, Walsh J. Pay now, benefits may follow - The case of cardiac computed tomography angiography. N Engl J Med 2008; 359: 2309-11.