title: Computerized left ventricular regional ejection fraction analysis for detection of ischemic coronary artery disease with multidetector CT angiography.
abstract: Regional ejection fraction (REF) provides important functional information of the left ventricular regional myocardium. We aimed to test the diagnostic accuracy of computerized REF analysis for detecting the ischemia and significant stenosis with multidetector CT angiography (MDCT). This is a retrospective study including 155 patients who underwent MDCT scans for evaluation of coronary artery disease. Among them, 83 patients also underwent SPECT imaging and invasive coronary angiography (ICA). Two groups of patients were defined: Control group with 0 coronary artery calcium and normal global and regional ventricular function, and comparison group. REF measurement was performed on all patients using computerized software. Control group REF measurements will be used as reference standard (mean-2SD REF/mean global ejection fraction) to define abnormal REF. The sensitivity, specificity, positive and negative predictive value of REF in detecting perfusion defects (fixed and reversible) was 73, 80, 75 and 79 % respectively, in a patient based analysis of comparison group. The diagnostic accuracy of REF in predicting significant stenosis (>50 %) on ICA compared with SPECT was 72 versus 61 % and 85 versus 79 % in patient and vessel based analysis of comparison group, respectively. ROC curve analysis showed REF to be a better predictor of perfusion defects on SPECT compared with significant stenosis (>50 %) alone or stenosis combined with REF (P < 0.05). The computerized assessment of REF analysis is comparable to SPECT in predicting ischemia and a better predictor of significant stenosis than SPECT. This study also provides reference standard to define abnormal values.
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, E5 Building, 1124 West Carson Street, Torrance, CA 90502, USA. irfanzeb82@yahoo.com
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Mohit
authors.initials: M
authors.lastname: Gupta
authors.forename: Jigar
authors.initials: J
authors.lastname: Kadakia
authors.forename: Yanlin
authors.initials: Y
authors.lastname: Gao
authors.forename: Eva
authors.initials: E
authors.lastname: Ma
authors.forename: Song Shou
authors.initials: SS
authors.lastname: Mao
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
mesh_terms: D000328:Adult; D000368:Aged; D001331:Automation; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000592:standards; D055414:Myocardial Perfusion Imaging / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012015:Reference Standards; D012042:Registries; D012189:Retrospective Studies; D012984:Software; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left