European Heart Journal Advance Access published online on February 21, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn044
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Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy
1 Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
2 Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
3 Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
4 Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
Received 5 March 2007; revised 19 December 2007; accepted 17 January 2008.
* Corresponding author. Tel: +41 1255 3662, Fax: +41 1255 4443, Email address: hatem.alkadhi{at}usz.ch
Aims: To prospectively investigate the diagnostic accuracy of dual-source computed tomography coronary angiography (CTCA) to diagnose coronary stenoses in relation to body mass index (BMI), Agatston score (AS), and heart rate (HR) as compared with catheter coronary angiography (CCA).
Methods and results: Hundred and fifty consecutive patients (47 female, mean age 62.9 ± 12.1 years) underwent dual-source CTCA without HR control. Patients were divided into subgroups depending on the median of their BMI (26.0 kg/m2), AS (194), and HR (66 b.p.m.). CCA was considered the standard of reference. Mean BMI was 26.5 ± 4.2 kg/m2 (range 18.3–39.1 kg/m2), mean AS was 309 ± 408 (range 0–4387), and HR was 68.5 ± 12.6 b.p.m. (range 35–102 b.p.m.). Diagnostic image quality was found in 98.1% of all segments (2020/2059). Considering not-evaluative segments at CTCA as false-positive, overall per-patient sensitivity, specificity, positive, and negative predictive value were 96.6%, 86.8%, 82.6%, and 97.5%, respectively. High HR did not deteriorate diagnostic accuracy of CTCA. High BMI and AS were associated with a decrease in per-patient specificity to 84.1% and 77.8%, respectively, while sensitivity and negative predictive value remained high.
Conclusion: Dual-source CTCA provides high diagnostic accuracy irrespective of the HR and serves as a modality to rule-out coronary artery stenoses even in patients with high BMI and AS.
Key Words: Dual-source CT coronary angiography • Calcium scoring • Body mass index • Heart rate • Conventional coronary angiography • Coronary artery disease
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  F. Cademartiri, E. Maffei, and N. R. Mollet Is dual-source CT coronary angiography ready for the real world? Eur. Heart J., March 2, 2008; 29(6): 701 - 703. [Full Text] [PDF]
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