Document Detail


Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain: from the ROMICAT trial.
MedLine Citation:
PMID:  20484542     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain.
METHODS AND RESULTS: We analyzed 356 patients (mean age, 53+/-12 years; 62% men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50%) were separately assessed by 2 independent readers. Incremental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive coronary artery disease, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74% (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10% increase in sensitivity to detect ACS by cardiac computed tomography (87%; 95% confidence interval, 70% to 96%) and significantly improved the overall accuracy (c-statistic: 0.88 versus 0.94 and 0.79 versus 0.88, for extent of plaque and presence of stenosis, respectively; both P<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89% sensitivity and 86% specificity in patients with significant stenosis (n=33) and 60% sensitivity and 86% specificity in patients with inconclusive coronary computed tomographic angiography (n=33).
CONCLUSIONS: Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS.
Authors:
Sujith K Seneviratne; Quynh A Truong; Fabian Bamberg; Ian S Rogers; Michael D Shapiro; Christopher L Schlett; Claudia U Chae; Ricardo Cury; Suhny Abbara; Thomas J Brady; John T Nagurney; Udo Hoffmann
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-05-19
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-21     Completed Date:  2010-08-12     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  375-83     Citation Subset:  IM    
Affiliation:
Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Charles River Plaza, Boston, MA 02114, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00990262
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / physiopathology,  radiography*
Acute Disease
Area Under Curve
Chest Pain / physiopathology,  radiography*
Contrast Media
Coronary Stenosis / radiography
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Rest
Risk Assessment
Risk Factors
Sensitivity and Specificity
Tomography, X-Ray Computed / methods*
Triage / statistics & numerical data
Ventricular Dysfunction, Left / physiopathology,  radiography*
Grant Support
ID/Acronym/Agency:
R01 HL080053/HL/NHLBI NIH HHS; R01 HL080053/HL/NHLBI NIH HHS; R01 HL080053-03/HL/NHLBI NIH HHS; T32HL076136/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Contrast Media
Comments/Corrections

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