Abstract 3300: The Impacts of Coronary Artery Calcium on the Diagnostic Accuracy in Detecting Stenoses Using 64-slice Spiral Computed Tomography

Objective: To investigate the diagnostic accuracy of 64-slice spiral computed tomography (MSCT) to coronary artery lesions, and to analyze the impacts of coronary artery calcium to diagnostic accuracy in detecting coronary artery lesions. Methods: Sixty patients underwent 64-slice spiral CT and conventional coronary angiography(CCA). Calciumscoring was estimated with plain scans, while 2D and 3D reconstruction were done with enhanced scans. The diagnostic accuracy of MSCT to detect significant lesions was evaluated regarding quantitative coronary angiography (QCA) as the standard of reference, and to analyze the impacts of coronary artery calcium on diagnostic accuracy. Results: A total of 797 segments can be diagnosed. The overall sensitivity, specificity, positive predictive value and negative predictive value of 64-slice spiral CT were 96%(174 of 182), 98%(601 of 615), 93%(174 of 188), and 99%(601 of 609) respectively. Within a total of 591 segments with calcium score =0 (Agatston score), the specificity was 100%(498 of 499)and the positive predictive value was 99%(86 of 87). However, 49 segments had a calcium score ≥100, with specificity at 63%(12 of 19)and positive predictive value at 81%(30 of 37). Conclusions: In patients with none or moderate coronary calcification, the 64-slice spiral CT coronary angiography allows for the reliable detection of coronary artery stenoses. Severe coronary artery calcification may still degrade the diagnostic specificity and positive predictive value of 64-slice spiral CT.

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Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner—Facing the Facts

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s3864 ◽

2010 ◽

Vol 4 ◽

pp. CMC.S3864 ◽

Cited By ~ 3

Author(s):

M. Wehrschuetz ◽

E. Wehrschuetz ◽

H. Schuchlenz ◽

G. Schaffler

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Potential ◽

Coronary Artery Stenoses ◽

Artery Disease ◽

Msct Angiography

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses. Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction ≥ 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a κ-value of 0.43. Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

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Laboratory and Echocardiographic parameters as predictors of Coronary artery Calcium score detected by multislice computed tomography coronary angiography

Zagazig University Medical Journal ◽

10.21608/zumj.2019.19059.1614 ◽

2019 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Mena Abdallah ◽

mahmoud shah ◽

ashraf dwedar ◽

mohamed mohamed

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Artery Calcium ◽

Multislice Computed Tomography ◽

Coronary Artery Calcium Score ◽

Calcium Score ◽

Computed Tomography Coronary Angiography ◽

Echocardiographic Parameters

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Influence of lesion location on the accuracy of CT derived FFR: head-to-head comparison with invasive FFR

European Heart Journal ◽

10.1093/ehjci/ehaa946.0158 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Moshage ◽

S Smolka ◽

S Achenbach ◽

F Ammon ◽

P Ferstl ◽

...

Keyword(s):

Coronary Angiography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Invasive Coronary Angiography ◽

Roc Curve Analysis ◽

Jude Medical ◽

Lesion Location ◽

Distal Vessel

Abstract Background The accuracy of CT-derived FFR (FFRCT) has been repeatedly reported. However, the influence of lesion location on accuracy is unknown. Therefore, we evaluated the diagnostic accuracy of FFRCT to detect lesion-specific ischemia and determined the influence of lesion location (proximal vs. distal vessel segments) compared to invasively measured FFR in patients with suspected CAD. Methods A total of 136 vessels in which “Dual-Source”-CT coronary angiography had been performed due to suspected CAD and who were further referred for invasive coronary angiography with invasive FFR measurement within three months of the index CT examination were retrospectively identified and screened for inclusion in this analysis. Patients with either left main coronary artery stenoses, bifurcation or ostial stenoses were excluded. Invasive FFR was measured using a pressure wire (CERTUS®, St. Jude Medical, Minnesota, USA or Verrata®, Volcano, San Diego, USA). FFRCT was calculated using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany). All vessels were analyzed by an experienced observer blinded to the results of invasive FFR. Stenoses with invasively measured FFR ≤0.80 were classified as hemodynamically significant. We evaluated the diagnostic accuracy of FFRCT in proximal vs. non-proximal vessel segments. Proximal lesions included stenoses located in segment one, six, eleven and twelve. All other stenoses were categorized as distal lesions. Results Out of 136 coronary stenoses, 47 (35%) were located in proximal segments and 89 (65%) lesions were located in distal segments. Compared to invasive FFR, the sensitivity of FFRCT to correctly identify/exclude hemodynamically significant stenoses in proximal vessel segments was 93% (95% CI: 68–99.8%) and the specificity was 100% (95% CI: 89–100%), compared to a sensitivity of 72% (95% CI: 46.5–90%) and a specificity of 87% (95% CI: 77–94%) for FFRCT in distal lesions. The positive predictive value was 100% and the negative predictive value was 97% (95% CI: 82.8–99.5%) compared to a positive predictive value of 59% (95% CI: 42–93.9%) and a negative predictive value of 93% (95% CI: 85.4–96.3%) for proximal vs. distal vessel segment, respectively. This corresponds to an accuracy of 98% vs. 84%, respectively (p=0.02). ROC-Curve analysis showed a slightly higher – albeit non-significant – area under the curve for FFRCT to detect hemodynamic relevance in proximal lesions compared to distal lesions (AUC 0.95, p<0.001 vs. AUC: 0.86, p<0.001, respectively, p=0.2). Conclusion FFRCT obtained using an on-site prototype shows overall a high diagnostic accuracy for detecting lesions causing ischemia as compared to invasive FFR with a trend towards better diagnostic performance in proximal vessel segments. Funding Acknowledgement Type of funding source: None

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Analyzing the predictive value of coronary artery calcium score to assess coronary artery disease events

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2009.04.050 ◽

2009 ◽

Vol 10 (3) ◽

pp. 209-210

Author(s):

Bassel Artin ◽

Amol Bahekar ◽

Ahmad Khraisat ◽

Rohit Bhuriya ◽

Sarabjeet Singh ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Artery Calcium ◽

Predictive Value ◽

Coronary Artery Calcium Score ◽

Calcium Score ◽

Artery Disease

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Abstract 5803: Optimal Threshold for Multi Detector Computer Tomography to Detect Physiologically Significant Stenosis in Patients with Ischemic Heart Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_106-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takashi Yamano ◽

Atsushi Tanaka ◽

Takashi Tanimoto ◽

Shigeho Takarada ◽

Hiroki Kitabata ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Optimal Threshold ◽

Fractional Flow ◽

Significant Stenosis ◽

Artery Disease

PURPOSE: Sixty-four multi detector computed tomography angiography (64-MDCT) has emerged as a rapidly developing method for the noninvasive detection of coronary artery disease with high negative predictive value and relatively low positive predictive value, especially in patients with intermediate-severity coronary artery disease (ISCAD). There are, however, few studies regarding with optimal threshold for detection of physiologically significant stenosis in 64-MDCT. The purpose of this study was to investigate the optimal threshold for 64-MDCT to detect physiologically significant stenosis using fractional flow reserve of the myocardium (FFRmyo) in patients with ISCAD. METHODS: We enrolled single lesions detected by 64-MDCT of 64 ISCAD patients (age, 68.3 +/− 10.2 years; 78% male). FFRmyo </= 0.75 measured by a 0.014-inch pressure wire was used as the gold standard for presence of physiologically significant stenosis. The area stenosis (%AS) in 64-MDCT were compared with the results of FFRmyo and percent diameter stenosis (%DS) in quantitative coronary angiography (QCA) during elective coronary angiography. Using receiver operating characteristic (ROC) analysis, the optimum threshold for percent area stenosis (%AS) in 64-MDCT was determined in the prediction of FFRmyo </= 0.75. RESULTS: There was an inverse correlation between %AS in 64-MDCT and FFRmyo (65 +/− 20 % and 0.71 +/− 0.16, respectively; r = −0.67; p < 0.01). Furthermore, there was a positive correlation between %AS in 64-MDCT and %DS in QCA (65 +/− 20 % and 63 +/− 19 %, respectively; r = 0.69; p < 0.01). Using a cutoff of 62 %AS in 64-MDCT, ROC curve analysis shows 79 % sensitivity, 85 % specificity, 82% positive predictive value, 83% negative predictive value and 83% accuracy for detecting physiologically significant stenosis. CONCLUSION: > 62 %AS in 64-MDCT could predict the physiologically significant coronary stenosis in patients with ISCAD. Applying an alternative threshold to detect physiologically significant stenosis might contribute to improve the diagnostic accuracy for 64-MDCT in patients with ISCAD.

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