Extension and Spatial Distribution of Atherosclerotic Burden Using Virtual Monochromatic Imaging Derived From Dual-energy Computed Tomography.
OBJECTIVE
We explored the differences between atherosclerotic burden with invasive coronary angiography and virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography.


METHODS
Eighty consecutive patients referred for invasive coronary angiography underwent dual-energy computed tomography coronary angiography and were categorized according to the atherosclerotic burden extent using the modified Duke prognostic coronary artery disease index, coronary artery disease extension score, segment involvement score, and the segment stenosis score.


RESULTS
The mean segment involvement score (8.2 ± 3.9 vs 6.0 ± 3.7; P < .0001), modified Duke index (4.33 ± 1.6 vs 4.0 ± 1.7; P = .003), coronary artery disease extension score (4.84 ± 1.8 vs 4.43 ± 2.1; P = .005), and the median segment stenosis score (13.5 [9.0-18.0] vs 9.5 [5.0-15.0]; P < .0001) were significantly higher on dual-energy computed tomography compared with invasive angiography. Dual-energy computed tomography showed a significantly higher number of patients with any left main coronary artery lesion (46 [58%] vs 18 [23%]; P < .0001) and with severe proximal lesions (0.28 ± 0.03 vs 0.26 ± 0.03; P < .0001) than invasive angiography. Levels of coronary artery calcification below and above the median showed a sensitivity, specificity, positive predictive value, and negative predictive value of 100% and 97%; 86% and 50%; 93% and 95%; 100% and 67% for the identification of ≥ 50% stenosis.


CONCLUSIONS
Dual-energy computed tomography coronary angiography identified a significantly larger atherosclerotic burden compared with invasive coronary angiography, particularly involving the proximal segments.
Departamento de Imágenes Cardiovasculares, Diagnóstico Maipú, Buenos Aires, Argentina. Electronic address: grodriguezgranillo@gmail.com.
Gastón A
GA
Rodríguez-Granillo
Departamento de Imágenes Cardiovasculares, Diagnóstico Maipú, Buenos Aires, Argentina.
Patricia
P
Carrascosa
Departamento de Imágenes Cardiovasculares, Diagnóstico Maipú, Buenos Aires, Argentina.
Alejandro
A
Deviggiano
Departamento de Imágenes Cardiovasculares, Diagnóstico Maipú, Buenos Aires, Argentina.
Carlos
C
Capunay
Departamento de Imágenes Cardiovasculares, Diagnóstico Maipú, Buenos Aires, Argentina.
Macarena C
MC
de Zan
Departamento de Cardiología Intervencionista, Sanatorio Güemes, Buenos Aires, Argentina.
Alejandro
A
Goldsmit
D000787:Angina Pectoris / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011446:Prospective Studies
Ateroesclerosis; Atherosclerosis; Left main coronary artery; Placa; Plaque; Tronco coronario izquierdo