title: Noninvasive detection of coronary vasospastic angina using a double-acquisition coronary CT angiography protocol in the presence and absence of an intravenous nitrate: a pilot study.
abstract: OBJECTIVE
  To evaluate the feasibility of a double-acquisition coronary CT angiography (CCTA) protocol in the presence and absence of an intravenous (IV) vasodilator infusion for detecting vasospastic angina.
  
  
  METHODS
  Twenty patients with a high clinical probability of vasospastic angina were enrolled. All subjects underwent baseline CCTA without a vasodilator in the early morning followed by a catheterized coronary angiography with ergonovine provocation test. Within 3 days, all subjects underwent repeat CCTA during a continuous IV infusion of nitrate. Vasospastic angina as detected by CCTA was defined as significant stenosis (≥50 %) with negative remodelling without definite plaques or diffuse small diameter (<2 mm) of a major coronary artery with a beaded appearance on baseline CT that completely dilated on IV nitrate CT. The CCTA results were compared to the catheterized ergonovine provocation test as the reference standard.
  
  
  RESULTS
  Among 20 patients, the catheterized ergonovine provocation test detected vasospasm in 15 patients. The sensitivity, specificity, positive predictive value and negative predictive value of CCTA in a per-patient-based analysis were 73, 100, 100 and 56 %, respectively.
  
  
  CONCLUSIONS
  Double-acquisition CCTA in the presence and absence of IV infusion of nitrate allows noninvasive detection of vasospastic angina with moderate sensitivity and high specificity.
  
  
  CONCLUSIONS
  • Limited data exist regarding the efficacy of CCTA in detecting vasospastic angina. • We propose a double-acquisition CCTA protocol with and without IV nitrate injections. • This protocol provides 100% specificity and moderate sensitivity (73%) in spasm detection.
authors.affiliation: Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Eun-Ju
authors.initials: EJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea. kimmh@dau.ac.kr.|Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea. kimmh@dau.ac.kr.
authors.forename: Moo Hyun
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea.|Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Cai
authors.initials: C
authors.lastname: De Jin
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea.
authors.forename: Jeongmin
authors.initials: J
authors.lastname: Seo
authors.affiliation: Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Seong Kuk
authors.initials: SK
authors.lastname: Yoon
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea.
authors.forename: Tae-Ho
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Ki-Nam
authors.initials: KN
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
authors.forename: Yeonyee Elizabeth
authors.initials: YE
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004874:Ergonovine; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004874:Ergonovine
keywords: Angina pectoris, variant; Computed tomography; Coronary angiography; Coronary vessels; Spasm