Document Detail


Relation of plaque characteristics defined by coronary computed tomographic angiography to ST-segment depression and impaired functional capacity during exercise treadmill testing in patients suspected of having coronary heart disease.
MedLine Citation:
PMID:  19101229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Sixty-four-detector-row coronary computed tomographic angiography (CCTA) has been proposed for the evaluation of low- to intermediate-risk patients with suspected coronary artery disease (CAD). Historically, exercise treadmill testing (ETT) measures of ST-segment depression (STD) and the Duke treadmill score (DTS) have been used to evaluate myocardial ischemia and functional capacity. The relation of plaque characteristics on CCTA to STD and DTS is unknown. In this study, 156 low- to intermediate-risk patients without known CAD who underwent ETT and CCTA were evaluated. By ETT, 22% (n = 35) had STD and 27% (n = 42) had abnormal DTS. On CCTA, 21% (n = 33) had obstructive CAD (>or=70% stenosis) and 49% (n = 77) had nonobstructive CAD (<70% stenosis). Forty-six percent of patients (n = 16) with and 15% (n = 15) without STD had obstructive CAD. After multivariate adjustment, only age and obstructive CAD on CCTA predicted STD (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.08 to 2.34 per decade, and OR 3.38, 95% CI 1.32 to 8.64, respectively) and abnormal DTS (OR 1.61, 95% CI 1.14 to 2.28, and OR 4.67, 95% CI 1.97 to 11.03, respectively). After adjustment for age, more coronary segments with mixed plaque, in contrast to calcified or noncalcified plaque, predicted STD (OR 1.48, 95% CI 1.18 to 1.85) and abnormal DTS (OR 1.30, 95% CI 1.05 to 1.61). In conclusion, measures of plaque on CCTA identify patients more likely to have STD and higher risk DTS, while providing incremental diagnostic yield for the detection of obstructive CAD beyond ETT.
Authors:
Fay Y Lin; Shahryar Saba; Jonathan W Weinsaft; Franklin J Wong; Massimo Szulc; Paul Kligfeld; Peter M Okin; Daniel S Berman; Leslee J Shaw; James K Min
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-10-23
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-22     Completed Date:  2009-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  50-8     Citation Subset:  AIM; IM    
Affiliation:
Weill Medical College of Cornell University and the New York Presbyterian Hospital, New York, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Coronary Angiography / methods*
Coronary Disease / physiopathology,  radiography*
Disease Progression
Electrocardiography*
Exercise Test / methods*
Exercise Tolerance / physiology*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Tomography, X-Ray Computed / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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