Skip to main content
Erschienen in: The International Journal of Cardiovascular Imaging 5/2012

01.06.2012 | Original Paper

Accuracy of dual-source CT to identify significant coronary artery disease in patients with uncontrolled hypertension presenting with chest pain: comparison with coronary angiography

verfasst von: Mohamed Marwan, Tobias Pflederer, Tiziano Schepis, Martin Seltmann, Lutz Klinghammer, Gerd Muschiol, Dieter Ropers, Werner G. Daniel, Stephan Achenbach

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

Abstract

It has been previously reported that the sensitivity and specificity of multislice CT for detecting significant CAD (coronary artery disease) is high. Chest pain is a common presentation in patients with uncontrolled hypertension. We investigated the sensitivity and specificity of Dual-Source CT to detect and rule out significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain. 260 consecutive patients presenting with acute chest pain in the context of stage 2 hypertension (systolic pressure ≥160 and/or diastolic pressure ≥100) were enrolled in the study. After admission, control of blood pressure and risk stratification, 82 patients were excluded due to renal insufficiency, prior coronary revascularisation or refused participation in the study. 90 further patients with low pre-test probability of CAD were also excluded. 88 remaining patients were subjected to CT coronary angiography using Dual-Source CT (Definition, Siemens Medical Solutions, Forchheim, Germany) within 24 h before invasive coronary angiography. A contrast-enhanced volume dataset was acquired (120 kV, 400 mAs/rot, collimation 2 × 64 × 0.6 mm, retrospective ECG gating). Data sets were evaluated concerning the presence or absence of significant coronary stenoses and validated against invasive coronary angiography. A significant stenosis was assumed if the diameter reduction was ≥50%. 88 patients (mean age 66 ± 11 years, mean heart rate 61 ± 9 bpm) were evaluated regarding the presence or absence of significant CAD (at least one stenosis ≥50% diameter reduction). Mean systolic blood pressure on presentation was 203 ± 20 mmHg and mean diastolic blood pressure was 103 ± 13 mmHg. On a per patient basis, the sensitivity and specificity for Dual-Source CT to detect significant CAD in vessels >1.5 mm diameter was 100% (36/36, 95% CI 90–100) and 90% (47/52, 95% CI 79–97), respectively with a negative predictive value (NPV) of 100% (47/47, 95% CI 92–100) and a positive predictive value (PPV) of 88% (36/41, 95% CI 74–96). On a per artery basis, 352 vessels were evaluated (left main, left anterior descending, left circumflex and right coronary artery in 88 patients, 12 vessels could not be assessed due to either motion artefacts or heavy calcification and were considered positive for stenoses) with a sensitivity of 84% (54/64, 95% CI 72–95) and specificity of 94% (272/288, 95% CI 88–100); NPV was 96% (272/282, 95% CI 90–100) and PPV was 77% (54/70, 95% CI 62–91). Our study demonstrates high sensitivity, specificity and negative predictive value of Dual-Source CT to detect significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain. Dual-Source CT angiography may be useful to safely rule out coronary artery stenoses and avoid invasive angiograms in these patients.
Literatur
1.
Zurück zum Zitat Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P (1996) Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension 27:144–147PubMedCrossRef Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P (1996) Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension 27:144–147PubMedCrossRef
2.
Zurück zum Zitat Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, Waugh N (2008) 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393PubMedCrossRef Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, Waugh N (2008) 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393PubMedCrossRef
3.
Zurück zum Zitat Sun Z, Jiang W (2006) Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis. Eur J Radiol 60:279–286PubMedCrossRef Sun Z, Jiang W (2006) Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis. Eur J Radiol 60:279–286PubMedCrossRef
4.
Zurück zum Zitat Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, Hunink MG (2007) Diagnostic performance of multidetector ct angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428PubMedCrossRef Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, Hunink MG (2007) Diagnostic performance of multidetector ct angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428PubMedCrossRef
5.
Zurück zum Zitat Achenbach S (2007) Cardiac ct: state of the art for the detection of coronary arterial stenosis. J Cardiovasc Comput Tomogr 1:3–20PubMedCrossRef Achenbach S (2007) Cardiac ct: state of the art for the detection of coronary arterial stenosis. J Cardiovasc Comput Tomogr 1:3–20PubMedCrossRef
6.
Zurück zum Zitat Andreini D, Pontone G, Pepi M, Ballerini G, Bartorelli AL, Magini A, Quaglia C, Nobili E, Agostoni P (2007) Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy. J Am Coll Cardiol 49:2044–2050PubMedCrossRef Andreini D, Pontone G, Pepi M, Ballerini G, Bartorelli AL, Magini A, Quaglia C, Nobili E, Agostoni P (2007) Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy. J Am Coll Cardiol 49:2044–2050PubMedCrossRef
7.
Zurück zum Zitat Ghostine S, Caussin C, Daoud B, Habis M, Perrier E, Pesenti-Rossi D, Sigal-Cinqualbre A, Angel CY, Lancelin B, Capderou A, Paul JF (2006) Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography. J Am Coll Cardiol 48:1929–1934PubMedCrossRef Ghostine S, Caussin C, Daoud B, Habis M, Perrier E, Pesenti-Rossi D, Sigal-Cinqualbre A, Angel CY, Lancelin B, Capderou A, Paul JF (2006) Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography. J Am Coll Cardiol 48:1929–1934PubMedCrossRef
8.
Zurück zum Zitat Hoffmann U, Nagurney JT, Moselewski F, Pena A, Ferencik M, Chae CU, Cury RC, Butler J, Abbara S, Brown DF, Manini A, Nichols JH, Achenbach S, Brady TJ (2006) Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 114:2251–2260PubMedCrossRef Hoffmann U, Nagurney JT, Moselewski F, Pena A, Ferencik M, Chae CU, Cury RC, Butler J, Abbara S, Brown DF, Manini A, Nichols JH, Achenbach S, Brady TJ (2006) Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 114:2251–2260PubMedCrossRef
9.
Zurück zum Zitat Meijboom WB, Mollet NR, Van Mieghem CA, Kluin J, Weustink AC, Pugliese F, Vourvouri E, Cademartiri F, Bogers AJ, Krestin GP, de Feyter PJ (2006) Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery. J Am Coll Cardiol 48:1658–1665PubMedCrossRef Meijboom WB, Mollet NR, Van Mieghem CA, Kluin J, Weustink AC, Pugliese F, Vourvouri E, Cademartiri F, Bogers AJ, Krestin GP, de Feyter PJ (2006) Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery. J Am Coll Cardiol 48:1658–1665PubMedCrossRef
10.
Zurück zum Zitat Meijboom WB, van Mieghem CA, Mollet NR, Pugliese F, Weustink AC, van Pelt N, Cademartiri F, Nieman K, Boersma E, de Jaegere P, Krestin GP, de Feyter PJ (2007) 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol 50:1469–1475PubMedCrossRef Meijboom WB, van Mieghem CA, Mollet NR, Pugliese F, Weustink AC, van Pelt N, Cademartiri F, Nieman K, Boersma E, de Jaegere P, Krestin GP, de Feyter PJ (2007) 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol 50:1469–1475PubMedCrossRef
11.
Zurück zum Zitat Scheffel H, Leschka S, Plass A, Vachenauer R, Gaemperli O, Garzoli E, Genoni M, Marincek B, Kaufmann P, Alkadhi H (2007) Accuracy of 64-slice computed tomography for the preoperative detection of coronary artery disease in patients with chronic aortic regurgitation. Am J Cardiol 100:701–706PubMedCrossRef Scheffel H, Leschka S, Plass A, Vachenauer R, Gaemperli O, Garzoli E, Genoni M, Marincek B, Kaufmann P, Alkadhi H (2007) Accuracy of 64-slice computed tomography for the preoperative detection of coronary artery disease in patients with chronic aortic regurgitation. Am J Cardiol 100:701–706PubMedCrossRef
12.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252PubMedCrossRef Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252PubMedCrossRef
13.
Zurück zum Zitat Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300:1350–1358PubMedCrossRef Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300:1350–1358PubMedCrossRef
15.
Zurück zum Zitat Jones SR, Carley S, Harrison M (2003) An introduction to power and sample size estimation. Emerg Med J 20:453–458PubMedCrossRef Jones SR, Carley S, Harrison M (2003) An introduction to power and sample size estimation. Emerg Med J 20:453–458PubMedCrossRef
16.
Zurück zum Zitat Drake C, Levine RA (2005) Sensitivity, specificity and other diagnostic measures with multiple sites per unit. Contemp Clin Trials 26:252–259PubMedCrossRef Drake C, Levine RA (2005) Sensitivity, specificity and other diagnostic measures with multiple sites per unit. Contemp Clin Trials 26:252–259PubMedCrossRef
18.
Zurück zum Zitat Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter accuracy (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRef Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter accuracy (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRef
19.
Zurück zum Zitat Tsiflikas I, Brodoefel H, Reimann AJ, Thomas C, Ketelsen D, Schroeder S, Kopp AF, Claussen CD, Burgstahler C, Heuschmid M (2010) Coronary ct angiography with dual source computed tomography in 170 patients. Eur J Radiol 74:161–165PubMedCrossRef Tsiflikas I, Brodoefel H, Reimann AJ, Thomas C, Ketelsen D, Schroeder S, Kopp AF, Claussen CD, Burgstahler C, Heuschmid M (2010) Coronary ct angiography with dual source computed tomography in 170 patients. Eur J Radiol 74:161–165PubMedCrossRef
20.
Zurück zum Zitat Rixe J, Conradi G, Rolf A, Schmermund A, Magedanz A, Erkapic D, Deetjen A, Hamm CW, Dill T (2009) Radiation dose exposure of computed tomography coronary angiography: comparison of dual-source, 16-slice and 64-slice ct. Heart 95:1337–1342PubMedCrossRef Rixe J, Conradi G, Rolf A, Schmermund A, Magedanz A, Erkapic D, Deetjen A, Hamm CW, Dill T (2009) Radiation dose exposure of computed tomography coronary angiography: comparison of dual-source, 16-slice and 64-slice ct. Heart 95:1337–1342PubMedCrossRef
21.
Zurück zum Zitat Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman DS (2008) Moving beyond binary grading of coronary arterial stenoses on coronary computed tomographic angiography: insights for the imager and referring clinician. JACC Cardiovasc Imaging 1:460–471PubMedCrossRef Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman DS (2008) Moving beyond binary grading of coronary arterial stenoses on coronary computed tomographic angiography: insights for the imager and referring clinician. JACC Cardiovasc Imaging 1:460–471PubMedCrossRef
Metadaten
Titel
Accuracy of dual-source CT to identify significant coronary artery disease in patients with uncontrolled hypertension presenting with chest pain: comparison with coronary angiography
verfasst von
Mohamed Marwan
Tobias Pflederer
Tiziano Schepis
Martin Seltmann
Lutz Klinghammer
Gerd Muschiol
Dieter Ropers
Werner G. Daniel
Stephan Achenbach
Publikationsdatum
01.06.2012
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 5/2012
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-011-9907-1

Weitere Artikel der Ausgabe 5/2012

The International Journal of Cardiovascular Imaging 5/2012 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.