title: Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain: from the ROMICAT trial.
abstract: BACKGROUND
  The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain.
  
  
  RESULTS
  We analyzed 356 patients (mean age, 53+/-12 years; 62% men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50%) were separately assessed by 2 independent readers. Incremental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive coronary artery disease, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74% (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10% increase in sensitivity to detect ACS by cardiac computed tomography (87%; 95% confidence interval, 70% to 96%) and significantly improved the overall accuracy (c-statistic: 0.88 versus 0.94 and 0.79 versus 0.88, for extent of plaque and presence of stenosis, respectively; both P<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89% sensitivity and 86% specificity in patients with significant stenosis (n=33) and 60% sensitivity and 86% specificity in patients with inconclusive coronary computed tomographic angiography (n=33).
  
  
  CONCLUSIONS
  Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS.
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Charles River Plaza, Boston, MA 02114, USA.
authors.forename: Sujith K
authors.initials: SK
authors.lastname: Seneviratne
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Ian S
authors.initials: IS
authors.lastname: Rogers
authors.forename: Michael D
authors.initials: MD
authors.lastname: Shapiro
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Claudia U
authors.initials: CU
authors.lastname: Chae
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cury
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000208:Acute Disease; D019540:Area Under Curve; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003287:Contrast Media; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012146:Rest; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014218:Triage / Q000706:statistics & numerical data; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D003287:Contrast Media