Effect of Heart Rate and Coronary Calcification on the Diagnostic Accuracy of the Dual-Source CT Coronary Angiography in Patients with Suspected Coronary Artery Disease.
10.3348/kjr.2009.10.4.347
- Author:
Lingdong MENG
1
;
Lianqun CUI
;
Yuntao CHENG
;
Xiaoyan WU
;
Yuansheng TANG
;
Yong WANG
;
Fayun XU
Author Information
1. Shandong Province Ji'nan 4th People's Hospital, Ji'nan 250031, China.
- Publication Type:Original Article
- Keywords:
Dual-source computed tomography;
Coronary artery disease;
Coronary angiography
- MeSH:
Calcinosis/*radiography;
Coronary Angiography/methods/*standards;
Coronary Disease/*radiography;
Coronary Vessels/*pathology;
Female;
*Heart Rate;
Humans;
Male;
Middle Aged;
Predictive Value of Tests;
Sensitivity and Specificity;
Tomography, X-Ray Computed/methods/*standards
- From:Korean Journal of Radiology
2009;10(4):347-354
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To evaluate the diagnostic accuracy of a dual-source computed tomography (DSCT) coronary angiography, with a particular focus on the effect of heart rate and calcifications. MATERIALS AND METHODS:One hundred and nine patients with suspected coronary disease were divided into 2 groups according to a mean heart rate (< 70 bpm and > or = 70 bpm) and into 3 groups according to the mean Agatston calcium scores (< or = 100, 101-400, and > 400). Next, the effect of heart rate and calcification on the accuracy of coronary artery stenosis detection was analyzed by using an invasive coronary angiography as a reference standard. Coronary segments of less than 1.5 mm in diameter in an American Heart Association (AHA) 15-segment model were independently assessed. RESULTS: The mean heart rate during the scan was 71.8 bpm, whereas the mean Agatston score was 226.5. Of the 1,588 segments examined, 1,533 (97%) were assessable. A total of 17 patients had calcium scores above 400 Agatston U, whereas 50 had heart rates > or = 70 bpm. Overall the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) for significant stenoses were: 95%, 91%, 65%, and 99% (by segment), respectively and 97%, 90%, 81%, and 91% (by artery), respectively (n = 475). Heart rate showed no significant impact on lesion detection; however, vessel calcification did show a significant impact on accuracy of assessment for coronary segments. The specificity, PPV and accuracy were 96%, 80%, and 96% (by segment), respectively for an Agatston score less than 100% and 99%, 96% and 98% (by artery). For an Agatston score of greater to or equal to 400 the specificity, PPV and accuracy were reduced to 79%, 55%, and 83% (by segment), respectively and to 79%, 69%, and 85% (by artery), respectively. CONCLUSION: The DSCT provides a high rate of accuracy for the detection of significant coronary artery disease, even in patients with high heart rates and evidence of coronary calcification. However, patients with severe coronary calcification (> 400 U) remain a challenge to diagnose.
