ABSTRACT
INTRODUCTION AND OBJECTIVES: Multislice computed tomography coronary angiography (MSCT-CA) has been developed in the last years. One of the advantages is to supply information of the lumen and wall of the vessels. The aim was to assess the diagnostic accuracy of MSCT - CA to detect significant coronary stenoses taking as gold standard the invasive coronary angiography (ICA). PATIENTS AND METHODS: We studied, after informed consent, 64 consecutive patients (50 males). First MSCT - CA was performed and afterwards with a media of 45 days the ICA. Sensitivity (SENS), specificity (ESP), positive predictive value (PPV), negative predictive value (NPV) and predictive precision (PP) were assessed per patients, per arteries and per segments. RESULTS: The SENS, ESP, PPV, PNV and PP were 96.4, 91.2, 87, 96.8, 93.5% respectively per patients and 95.7, 97, 88.2, 98.9, 96.7% respectively per arteries and 91, 99, 89, 99.6, 98.7% respectively per segments. The diagnostic accuracy decreased in patients with heart rate higher than 65 beats per minute, as well as in patients with calcium scoring higher than 400 Agatston Units or body mass index with or higher than 30 kg/m2 CS. CONCLUSIONS: Our results suggest that MSCT - CA has a good accuracy, especially in the ESP and NPV for the diagnosis of significant coronary stenoses in selected patients with calcium scoring of 400 Agatston Units or lower, heart rate with 65 beats per minute or lower with regular rhythm and body mass index lower than 30 kg/m2 CS.
Subject(s)
Female , Humans , Male , Middle Aged , Angiography/methods , Coronary Artery Disease , Tomography, X-Ray Computed , Reproducibility of ResultsABSTRACT
La coronariografía invasiva (CI) constituye el patrón de referencia para el estudio de las arterias coronarias. Se ha planteado que la tomografía computarizada de múltiples cortes (TCMC) puede evitar la CI. Se estudiaron 62 pacientes, 50 del sexo masculino, edad media 56 ± 8 años para evaluar la precisión diagnóstica de la TCMC de 64 cortes en la detección de estenosis coronarias significativas (ECS), comparándola con la CI. Se les realizó la CI por presentar ECS o persistencia de los síntomas. Se determinó sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo (VPN) y precisión predictiva (PP) por pacientes y por arterias. La S, la E, el VPP, el VPN y la PP fueron 96,4; 91,2; 87; 96,8 y 93,5 por ciento, respectivamente, por pacientes, y 95,7; 97; 88,2; 98,9 y 96,7 por ciento, respectivamente, por arterias. Se concluyó que la TCMC puede sustituir la CI en pacientes seleccionados.
Invasive coronariography (IC) is the reference pattern for the study of coronary arteries. It has been stated that multiple slice computed tomography (MSCT) may avoid IC. 62 patients, 50 of whom were males, with mean age 56 ± 8, were studied to evaluate the diagnostic accuracy of the 64-slice MSCT in the detection of significant coronary stenoses (SCS), comparing it with IC. IC was performed due to the presence of SCS or persistence of the symptoms. Sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPV) and predictive accuracy (PA) were determined by patients and arteries. S, E, PPV, NPV and PA were 96.4; 91.2; 87; 96.8 and 93.5 percent per patient, respectively; whereas they were 95.7; 97; 88.2; 98.9 and 96.7 percent by artery, respectively. It was concluded that MSCT may replace IC in selected patients.
Subject(s)
Humans , Male , Adult , Coronary Stenosis/diagnosis , Tomography/methodsABSTRACT
Introducción y Objetivos La coronariografía invasiva (CI) es el patrón estándar para el estudio de las coronarias con un bajo índice de complicaciones. La tomografía computarizada multicorte (TCMC) permite el estudio mínimamente invasivo del árbol coronario. El objetivo del presente trabajo estuvo dirigido a determinar la precisión de la TCMC para detectar estenosis coronaria significativa (ECS) según puntaje de calcio y frecuencia cardíaca. Material y métodos Se estudiaron 62 pacientes, 50 del sexo masculino, a los que se les realizó primero la coronariografía por TCMC y luego la CI, con una media de 45 días, previo consentimiento informado. Se determinaron la sensibilidad (S), la especificidad (E), el valor predictivo positivo (VPP), el valor predictivo negativo (VPN) y la precisión predictiva (PP) por paciente y arterias según puntaje de calcio y frecuencia cardíaca. Resultados La S, la E, el VPP, el VPN y la PP por arterias fueron, respectivamente, con puntaje de calcio menor o igual a 400 UA del 98%, 98%, 89%, 99% y 98% y con puntaje mayor de 400 UA, del 75%, 50%, 75%, 50% y 67%. En los 54 pacientes con frecuencia cardíaca menor o igual a 65 latidos por minuto, la S, la E, el VPP, el VPN y la PP fueron del 100%, 96%, 96%, 100% y 98,1% y en los 8 pacientes con frecuencia cardíaca mayor de 65 latidos por minuto fueron del 50%, 66,7%, 33%, 80% y 62,5%, respectivamente. Conclusiones El puntaje de calcio por encima de 400 UA por paciente y arterias, como también la frecuencia cardíaca mayor de 65 latidos por minuto, disminuyen la precisión diagnóstica de ECS a través de la TCMC.
Introduction and Objectives Invasive coronariography (IC) is the gold standard for the study of coronary arteries with a low percentage of complications. Multislice computerized tomography (MSCT) allows the minimally invasive study of the coronary tree. The objective of the present study was aimed at determining the accuracy of MSCT in the detection of significant coronary stenosis (SCS) by calcium score and heart rate. Material and Methods The 62 patients enrolled in the study (50 males) underwent a coronariography with MSCT, and later the IC, with a mean of 45 days, after signature of an informed consent. Sensitivity (Se) was assessed, as well as specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy (PA) per patient and arteries, according to calcium score and heart rate. Results Se, Sp, PPV, NPV and PA per arteries, with a calcium score lower or equal to 400 AU were, respectively 98%, 98%, 89%, 99% and 98%, and with a score higher than 400 AU, of 75%, 50%, 75%, 50% and 67%. In 54 patients with heart rate lower or equal to 65 beats per minute, Se, Sp, PPV, NPV and PA were 100%, 96%, 96%, 100% and 98,1% and in the 8 patients with heart rate higher than 65 beats per minute were 50%, 66.7%, 33%, 80% and 62.5%, respectively. Conclusions Calcium score above 400 AU per patient and arteries, as well as the heart rate over 65 beats per minute, decrease the diagnostic accuracy of SCS by means of MSCT.