| Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease. | |
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MedLine Citation:
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PMID: 22146498 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Preliminary studies have shown the potential of myocardial computed tomography perfusion (CTP) analysis for ischemia detection in both animals and humans. OBJECTIVE: To provide validation data on stress-rest CTP protocols as additive tools to improve the accuracy of multidetector computed tomography (MDCT) for coronary artery disease (CAD) in symptomatic patients. METHODS: Ninety symptomatic patients with suspected CAD (62 ± 8 years, 66% males) underwent both MDCT and invasive coronary angiography (XA). The MDCT protocol included a prospective calcium score acquisition, a helical acquisition with retrospective gating during infusion of adenosine (140 μg/kg/min) and a prospective scan for computed tomography angiography (CTA) at rest (total effective radiation dose: 5.1 ± 0.8 mSv). Significant and higher-grade CADs were defined by the presence of ≥50% or ≥70% stenosis in at least one coronary artery, as evaluated by quantitative coronary angiography (QCA) using XA images. RESULTS: On a patient-based model, CTA sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) to detect ≥50% or ≥70% stenosis were 98%, 71%, 80%, and 97% (global accuracy 86%) and 100%, 60%, 64%, and 100% (accuracy 77%), respectively. An integrative approach of CTA and CTP results had the best performance for detection of CAD with sensitivity of 83%, specificity of 98%, PPV of 98%, and NPV of 84% (accuracy 84%) for detection of 50% stenosis and 97%, 90%, 88%, and 98% (accuracy 93%), respectively, for the 70% threshold. The integration of results had the best overall performance in all scenarios but was particularly advantageous in the prediction of higher-grade CAD, with an area under the curve of 0.93, compared with 0.80 for isolated CTA and 0.82 for CTP and in patients with severe calcifications (sensitivity 92%, specificity 87%, overall accuracy of 90%). CONCLUSIONS: The integration of functional and morphological data using CTA and CTP improved MDCT accuracy for detection of clinically relevant CAD at both thresholds of 50% and 70% in this intermediate to high pretest probability population. |
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Authors:
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Nuno Bettencourt; João Rocha; Nuno Ferreira; Gustavo Pires-Morais; Mónica Carvalho; Daniel Leite; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Madalena Teixeira; Lino Simões; Adelino Leite-Moreira; Silva Cardoso; Eike Nagel; Vasco Gama |
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Publication Detail:
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Type: Journal Article Date: 2011-10-22 |
Journal Detail:
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Title: Journal of cardiovascular computed tomography Volume: 5 ISSN: 1876-861X ISO Abbreviation: J Cardiovasc Comput Tomogr Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-12-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101308347 Medline TA: J Cardiovasc Comput Tomogr Country: United States |
Other Details:
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Languages: eng Pagination: 392-405 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiology, Centro Hospitalar de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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