Accuracy of 16-detector multislice spiral computed tomography in the initial evaluation of dilated cardiomyopathy.
BACKGROUND
Multislice Computed Tomography (MSCT) recently proved its accuracy in the detection of coronary artery disease (CAD). It can also give information about left ventricular function and venous network anatomy. We here sought to validate a MSCT-based strategy in the initial evaluation of patients with dilated cardiomyopathy (DCM).


METHODS
36 patients with DCM underwent cardiac MSCT before conventional coronary angiography with ventriculography. We analysed arterial calcium score (Agatston score equivalent: ASE), coronary stenosis, left ventricular parameters and venous network.


RESULTS
The sensitivity of a MSCT-based strategy in detecting significant CAD was 100% and the specificity 80%. The positive and negative predictive values were respectively 67% and 100%. For ASE <1.000 (75% of patients), MSCT detected all non-CAD patients without one (motion artifacts), enabling conventional angiography to be avoided in 21/27 patients (77.7%). For ASE > or =1000, MSCT enabled conventional angiography to be avoided in only 2/9 patients (22.2%). The ventricle was assessable in 83.4% (30 patients) on MSCT. Correlation coefficient Rs with ventriculography were 0.78 (p<0.0001), 0.77 (p<0.0001) and 0.82 (p<0.0001) respectively for end-diastolic volume, end-systolic volume and EF. The venous network was assessable in all patients both on MSCT and angiography.


CONCLUSIONS
In patients undergoing an initial evaluation of DCM, MSCT appears to be an effective alternative to conventional angiography. The following attitude may be proposed: when ASE >1.000, conventional coronary angiography is mandatory due to MSCT's poor interest in such cases; when ASE <1.000, a contrast-enhanced MSCT may, when normal, replace coronary angiography.
Cornily
Jean-Christophe
JC
Department of Cardiology, Brest University Hospital, France. jean-christophe.cornily@chu-brest.fr
Gilard
Martine
M
Le Gal
Grégoire
G
Pennec
Pierre-Yves
PY
Vinsonneau
Ulric
U
Blanc
Jean-Jacques
JJ
Mansourati
Jacques
J
Boschat
Jacques
J
D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011856:Radiographic Image Enhancement / Q000295:instrumentation* / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000295:instrumentation* / Q000379:methods; D014159:Transducers