title: Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy.
abstract: OBJECTIVE
  To prospectively investigate the diagnostic accuracy of dual-source computed tomography coronary angiography (CTCA) to diagnose coronary stenoses in relation to body mass index (BMI), Agatston score (AS), and heart rate (HR) as compared with catheter coronary angiography (CCA).
  
  
  RESULTS
  Hundred and fifty consecutive patients (47 female, mean age 62.9 +/- 12.1 years) underwent dual-source CTCA without HR control. Patients were divided into subgroups depending on the median of their BMI (26.0 kg/m2), AS (194), and HR (66 b.p.m.). CCA was considered the standard of reference. Mean BMI was 26.5 +/- 4.2 kg/m2 (range 18.3-39.1 kg/m2), mean AS was 309 +/- 408 (range 0-4387), and HR was 68.5 +/- 12.6 b.p.m. (range 35-102 b.p.m.). Diagnostic image quality was found in 98.1% of all segments (2020/2059). Considering not-evaluative segments at CTCA as false-positive, overall per-patient sensitivity, specificity, positive, and negative predictive value were 96.6%, 86.8%, 82.6%, and 97.5%, respectively. High HR did not deteriorate diagnostic accuracy of CTCA. High BMI and AS were associated with a decrease in per-patient specificity to 84.1% and 77.8%, respectively, while sensitivity and negative predictive value remained high.
  
  
  CONCLUSIONS
  Dual-source CTCA provides high diagnostic accuracy irrespective of the HR and serves as a modality to rule-out coronary artery stenoses even in patients with high BMI and AS.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland. hatem.alkadhi@usz.ch
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Lotus
authors.initials: L
authors.lastname: Desbiolles
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Gerhard W
authors.initials: GW
authors.lastname: Goerres
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Luescher
authors.forename: Michele
authors.initials: M
authors.lastname: Genoni
authors.forename: Borut
authors.initials: B
authors.lastname: Marincek
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002114:Calcinosis / Q000150:complications*; D017023:Coronary Angiography / Q000592:standards*; D003324:Coronary Artery Disease / Q000150:complications*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*