Multislice cardiac computed tomography in symptomatic middle-aged women

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.