title: Cardiac multidetector-row computed tomography in patients with unstable angina.
abstract: Ideally, information on coronary artery stenosis and left ventricular (LV) function is obtained in patients who have unstable angina to allow optimal risk stratification. The value of multidetector-row computed tomography (MDCT) was evaluated for a simultaneous assessment of coronary artery disease and global/regional LV function using a single acquisition. Twenty-five patients who had unstable angina underwent a single multidetector-row computed tomographic acquisition using a 4-slice multidetector-row computed tomographic system. Based on retrospective electrocardiographic gating, images and cine movies were reconstructed, which allowed 2 independent observers to analyze the 9 major coronary artery segments and global/regional LV function. Conventional angiography (with quantitative analysis) and echocardiography served as standards of reference, which were performed </=2 +/- 2.7 days and </=3 hours, respectively, after multidetector-row computed tomographic investigations. Sensitivity, specificity, positive and negative predictive values, and correlations were calculated. Of 225 coronary artery segments, 182 (81%) were assessable by MDCT. Significant (>/=50%) coronary artery stenosis was detected with sensitivities, specificities, and positive and negative predictive values of 95%, 91%, 85%, and 97% for observer 1 and 89%, 87%, 79%, and 94% for observer 2, respectively; the interobserver kappa value was 0.73. MDCT showed excellent agreement with echocardiography for regional wall motion (90%; kappa = 0.88) and LV ejection fraction (correlation 0.95%, mean difference 0.7 +/- 3.9). Thus, MDCT can simultaneously assess coronary artery disease and LV function in patients who have unstable angina. High accuracies in excluding significant coronary artery disease and in confirming normal LV function were observed, suggesting potential clinical use for screening of patients who present with symptoms of unstable angina.
authors.affiliation: Department of Radiology, Leiden University Medical Center, The Netherlands.
authors.forename: Martijn S
authors.initials: MS
authors.lastname: Dirksen
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Joan C
authors.initials: JC
authors.lastname: Tuinenburg
authors.forename: Jacob
authors.initials: J
authors.lastname: Geleijns
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
mesh_terms: D000789:Angina, Unstable / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*