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Published on: August 28, 2018
Low-dose CT coronary angiography for the prediction of myocardial ischaemia
Paul Stolzmann1, Olivio F Donati, Hans Scheffel
1Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Insights
Low-dose computed tomography coronary angiography (CTCA) reliably rules out significant coronary artery disease (CAD). However, CTCA is not a strong predictor of myocardial ischemia, despite good image quality and diagnostic accuracy.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) diagnosis requires accurate assessment of functional relevance.
- Cardiac magnetic resonance (CMR) is a valuable tool for evaluating myocardial perfusion.
- Low-dose computed tomography coronary angiography (CTCA) offers potential for non-invasive CAD assessment.
Purpose of the Study:
- To prospectively evaluate the diagnostic accuracy of low-dose CTCA for functionally relevant CAD.
- To compare low-dose CTCA findings with CMR, used as the reference standard.
- To determine the reliability of low-dose CTCA in identifying hemodynamically significant coronary stenoses.
Main Methods:
- Prospective study involving 41 patients undergoing both low-dose CTCA and CMR within 24 hours.
- CMR utilized accelerated k-space and time broad-use linear acquisition speed-up technique (1.5 T).
- Dual-source CTCA employed prospective electrocardiography gating; analysis focused on stenoses >50% and >75% diameter reduction.
Main Results:
- Low-dose CTCA provided diagnostic image quality in 99.5% of analyzed coronary segments (39/41 patients).
- Perfusion defects, indicating functional relevance, were identified in 51% of patients by CMR.
- Low-dose CTCA showed 89% sensitivity and 83% accuracy for detecting stenoses >50% diameter, but was a poor predictor of perfusion defects (72% PPV).
Conclusions:
- Low-dose CTCA is a reliable method for excluding functionally significant coronary artery disease.
- While accurate for anatomical stenosis detection, low-dose CTCA has limitations in predicting myocardial ischemia.
- Further research may explore combined imaging approaches for comprehensive CAD assessment.
Abstract:
The purpose of this study was to prospectively determine the accuracy of low-dose computed tomography coronary angiography (CTCA) for the diagnosis of functionally relevant coronary artery disease (CAD) using cardiac magnetic resonance (CMR) as a standard of reference. Forty-one consecutive patients (age 64 +/- 10 years) underwent k-space and time broad-use linear acquisition speed-up technique accelerated CMR (1.5 T) and dual-source CTCA using prospective electrocardiography gating within 1 day. CTCA lesions were analysed and diameter stenoses of more than 50% and more than 75% were compared with CMR findings taken as the reference standard for assessing the functional relevance of CAD. CMR revealed perfusion defects in 21/41 patients (51%). A total of 569 coronary segments were analysed with low-dose CTCA. The image quality of low-dose CTCA was diagnostic in 566/569 segments (99.5%) in 39/41 patients (95%). Low-dose CTCA revealed stenoses of more than 50% in 58/123 coronary arteries (47.2%) in 24/41 patients (59%) and more than 75% stenoses in 46/123 coronary arteries (37.4%) in 23/41 patients (56%). Using a greater than 50% diameter stenosis, low-dose CTCA yielded the following per artery sensitivity, specificity, positive and negative predictive values, and accuracy for the detection of perfusion defects: 89%, 79%, 72%, 92% and 83%, respectively. Low-dose CTCA is reliable for ruling out functionally relevant CAD, but is a poor predictor of myocardial ischaemia.
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An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...