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
Korean Journal of Radiology
;
: 347-354, 2009.
Article
in English
| WPRIM
| ID: wpr-65292
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 ANDMETHODS:
One hundred and nine patients with suspected coronary disease were divided into 2 groups according to a mean heart rate ( or = 70 bpm) and into 3 groups according to the mean Agatston calcium scores ( 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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Calcinosis
/
Tomography, X-Ray Computed
/
Predictive Value of Tests
/
Sensitivity and Specificity
/
Coronary Angiography
/
Coronary Disease
/
Coronary Vessels
/
Heart Rate
Type of study:
Diagnostic study
/
Prognostic study
Limits:
Female
/
Humans
/
Male
Language:
English
Journal:
Korean Journal of Radiology
Year:
2009
Type:
Article
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