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Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease
D M Shavelle1, M J Budoff, D H LaMont
1Saint John's Cardiovascular Research Center, Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, California, USA. dshav@u.washington.edu.
Insights
Electron beam computed tomography (EBCT) shows higher diagnostic ability for obstructive coronary artery disease (CAD) than traditional stress tests. EBCT is an accurate, noninvasive alternative for evaluating symptomatic patients with suspected CAD.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Traditional stress tests like treadmill-ECG have limitations, including reliance on normal resting ECG and patient exercise capacity.
- Myocardial imaging agents improve sensitivity but increase cost and test duration.
- Electron beam computed tomography (EBCT) offers a rapid, noninvasive method to detect coronary artery calcium (CC), linked to atherosclerosis.
Purpose of the Study:
- To compare the diagnostic accuracy of EBCT for coronary artery calcium (CC) with conventional stress testing methods.
- To evaluate EBCT's role in assessing patients with symptoms suggestive of coronary artery disease (CAD).
Main Methods:
- 97 patients with chest pain underwent technetium stress testing, treadmill-ECG, and EBCT coronary scanning.
- All imaging was performed within three months of coronary angiography for comparison.
Main Results:
- EBCT demonstrated a higher relative risk (RR) for obstructive angiographic CAD (4.53) compared to treadmill-ECG (1.72) and technetium-stress (1.96).
- EBCT's initial low specificity (47%) was significantly improved to 83% when combined with treadmill-ECG (p < 0.05).
Conclusions:
- EBCT exhibits superior diagnostic capability for detecting obstructive CAD compared to treadmill-ECG and technetium-stress.
- EBCT serves as an accurate and noninvasive alternative to conventional stress testing for obstructive CAD in symptomatic individuals.
Objectives:
This study compared coronary artery calcium (CC) as detected by electron beam computed tomography (EBCT) with conventional stress testing in the evaluation of patients with symptoms suggestive of coronary artery disease (CAD).
Background:
Exercise electrocardiogram treadmill stress testing (treadmill-ECG) is limited by its requirement of a normal resting ECG and the ability of the patient to exercise adequately. The addition of myocardial imaging agents such as technetium improves the sensitivity and specificity but substantially increases the cost and prolongs the testing time. The use of EBCT provides a noninvasive and rapid method for identifying the presence and amount of CC, which has been shown to be related to atherosclerosis, and may provide additional information in combination with more traditional noninvasive testing methods.
Methods:
A total of 97 patients underwent technetium stress testing (technetium-stress), treadmill-ECG, and EBCT coronary scanning within three months of coronary angiography for the evaluation of chest pain.
Results:
The relative risk (RR) of obstructive angiographic CAD for an abnormal test was higher for EBCT (4.53) than either treadmill-ECG (1.72) or technetium-stress (1.96). The low specificity of EBCT (47%) was improved by the addition of treadmill-ECG (83%, p < 0.05).
Conclusions:
Electron beam computed tomography has a higher diagnostic ability than either treadmill-ECG or technetium-stress for the detection of obstructive angiographic CAD. Electron beam computed tomography is an accurate and noninvasive alternative to traditional stress testing for the detection of obstructive CAD in symptomatic patients.
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