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European Heart Journal Advance Access originally published online on July 21, 2007
European Heart Journal 2007 28(19):2354-2360; doi:10.1093/eurheartj/ehm294
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease

Alexander W. Leber1,*,{dagger}, Thorsten Johnson2,{dagger}, Alexander Becker1, Franz von Ziegler1, Janine Tittus1, Konstantin Nikolaou2, Maximilian Reiser2, Gerhard Steinbeck1, Christoph R. Becker2 and Andreas Knez1,{dagger}

1 Department of Cardiology, University of Munich, Klinikum Grosshadern, Medizinische Klinik I, Marchioninistraße 15, 81377 München, Germany
2 Department of Clinical Radiology, University of Munich, Klinikum Grosshadern, München, Germany

Received 24 January 2007; revised 23 May 2007; accepted 14 June 2007; online publish-ahead-of-print 21 July 2007.

* Corresponding author. Tel: +49 89 70953051; fax: +49 89 70952224. E-mail address: aleber{at}med.uni-muenchen.de

See page 2305 for the editorial comment on this article (doi:10.1093/eurheartj/ehm348)

Aims: The aim of the present study was to assess the clinical performance of a dual X-ray source multi-slice CT (MSCT) with high temporal resolution to assess the coronary status in patients with an intermediate pretest likelihood for significant coronary artery disease (CAD) without using negative chronotropic pretreatment.

Methods and results: Dual-source CT (DSCT) angiography (Siemens Definition) was performed in 90 patients with an intermediate likelihood for CAD who were referred for invasive coronary angiography. DSCT generated data sets with diagnostic image quality in 88 of the overall 90 patients. In six of seven patients with atrial fibrillation and in 46 of 48 patients with heart rates (HR) >65 b.p.m. image quality was diagnostic. In 20 of 21 patients with at least one stenosis >50% (sensitivity 95%) were correctly identified by DSCT-angiography. In 60 of 67 patients, a lesion >50% was correctly excluded (specificity 90%; positive predictive value 74%). The accuracy to detect patients with coronary stenoses >50% (sensitivity 92 vs. 100%; specificity 88 vs. 91%) was not significantly different among patients with HR >65 b.p.m. (n = 46) and <65 b.p.m. The concordance of DSCT-derived stenosis quantification showed good correlation (r = 0.76; P < 0.001) to quantitative coronary angiography with a slight trend to overestimate the stenosis degree.

Conclusion: DSCT is a non-invasive tool that allows to accurately rule out coronary stenoses in patients with an intermediate pretest likelihood for CAD, independent of the HR.

Key Words: Dual-source CT • Computed tomography • Coronary artery disease • Multi-slice CT

{dagger} Alexander W. Leber, Thorsten Johnson and Andreas Knez contributed equally to the study.


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