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European Heart Journal Advance Access published online on July 17, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl155
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received April 13, 2006
Revised June 21, 2006
Accepted June 29, 2006

Clinical research

Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries

Patrizia Malagutti 1, Koen Nieman 1 *, Willem B. Meijboom 1, Carlos A.G. van Mieghem 1, Francesca Pugliese 1, Filippo Cademartiri 1, Nico R. Mollet 1, Eric Boersma 2, Peter P. de Jaegere 2, and Pim J. de Feyter 1

1 Department of Cardiology, Thorax Centre, Erasmus Medical Center, PO Box 2040, Rotterdam 3000CA, The Netherlands; Department of Radiology, Thorax Centre, Erasmus Medical Center, PO Box 2040, Rotterdam 3000CA, The Netherlands
2 Department of Cardiology, Thorax Centre, Erasmus Medical Center, PO Box 2040, Rotterdam 3000CA, The Netherlands

* To whom correspondence should be addressed.
Koen Nieman, E-mail: koennieman{at}hotmail.com


  Abstract

Aims Although previous generations of multislice computed tomography (CT) have demonstrated accurate detection of obstructive bypass graft disease, progression of coronary disease is a more frequent cause for ischaemic symptoms late after bypass graft surgery. We explored the diagnostic performance of 64-slice CT in symptomatic patients after bypass surgery, for the assessment of both grafts and native coronary arteries.

Methods and results The 64-slice CT angiography (Siemens Sensation 64, Germany) was performed in 52 symptomatic patients, 10 ± 5 years after bypass surgery. Two independent, blinded observers assessed all grafts and coronary arteries for stenosis, using conventional quantitative angiography as a reference. A total of 109 grafts (182 graft segments), 123 distal coronary run-offs, and 116 non-bypassed coronary branches (288 segments) were analysed. Per-segment detection of graft disease yielded a sensitivity of 99% (71/72) and specificity of 96% (106/110). Sensitivity and specificity to detect run-off disease were 89% (8/9) and 93% (106/114), positive predictive value was 50% (8/16). In non-grafted coronary segments, CT detected significant stenosis with a sensitivity and specificity of 97% (62/64) and 86% (192/224). Overestimation occurred more frequently in calcified segments (P = 0.002).

Conclusion The 64-slice CT allows angiographic evaluation of grafts and coronary arteries, although overestimation of coronary obstruction occurs, particularly in the presence of calcified disease.

Keywords: Computed tomography; Coronary angiography; Coronary artery disease; Coronary artery bypass surgery; Imaging.
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