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Multislice cardiac computed tomography in symptomatic middle-aged women
Bharati Shivalkar1, Inge Goovaerts, Rodrigo A Salgado
1Department of Cardiology, University Hospital Antwerp, Belgium. Bharati.shivalkar@skynet.be
Insights
Multislice cardiac computed tomography (MSCT) accurately detects significant coronary artery disease (CAD) in middle-aged women with chest pain. This imaging technique showed excellent negative predictive value for identifying coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Coronary artery disease (CAD) is a significant health concern in middle-aged women presenting with symptoms like chest pain or dyspnea.
- An abnormal exercise electrocardiogram (ECG) often necessitates further diagnostic evaluation for suspected CAD.
Purpose of the Study:
- To evaluate the diagnostic accuracy of multislice cardiac computed tomography (MSCT) in detecting significant coronary artery disease (CAD).
- To assess MSCT's performance specifically in middle-aged women experiencing symptoms suggestive of CAD and exhibiting abnormal stress test results.
Main Methods:
- A cohort of 70 middle-aged women (average age 51 years) with chest pain or dyspnea and abnormal exercise ECG underwent MSCT.
- Coronary arteriography (CA) served as the gold standard for comparison.
- Results from MSCT and CA were analyzed blindly using segment, vessel, and patient-based approaches.
Main Results:
- MSCT identified significant CAD requiring revascularization in 24% of the women; 36% had normal coronaries, and the rest had mild CAD.
- At the segment level, MSCT demonstrated high accuracy for significant CAD, with a negative predictive value of 95% and specificity of 99%.
- Excellent agreement (98%, kappa 0.89) was observed between MSCT and CA for identifying significant CAD.
Conclusions:
- In symptomatic middle-aged women with abnormal stress tests, a substantial proportion (24%) had significant CAD requiring intervention.
- MSCT proved to be a highly accurate tool for diagnosing significant CAD, particularly noted for its excellent negative predictive value in this population.
Objective:
To assess the accuracy of multislice cardiac computed tomography (MSCT) for detection of significant coronary artery disease (CAD) in middle-aged symptomatic women.
Methods:
We included 70 women (51+/-8 years) with complaints of chest pain or dyspnea, and an abnormal maximum exercise electrocardiogram (ECG) (8.6+/-1.4 metabolic equivalents). All had a MSCT using a 16 detector rows scanner, and coronary arteriography (CA). Blinded results of the two modalities were compared using a segment, vessel, and patient-based analysis.
Results:
On MSCT 36% had normal coronaries, 24% had significant CAD requiring revascularization, and the remainder had mild CAD. MSCT had reasonably high diagnostic accuracy at segment level (negative predictive value of 95%, positive predictive value 81%, specificity 99%, and sensitivity 50%), regarding single or multivessel CAD when both nonassessable and assessable segments were included in the analysis. The agreement between the segments comparing MSCT and CA for significant CAD was excellent at 98% (kappa value 0.89).
Conclusions:
In this cohort of middle-aged symptomatic women with an abnormal stress test, 24% had significant CAD requiring intervention. MSCT was highly accurate in diagnosing significant CAD with an excellent negative predictive value.
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