Early detection of coronary artery disease by 64-slice multidetector computed tomography in asymptomatic hypertensive high-risk patients

Gaudio, Carlo; Mirabelli, Francesca; Pelliccia, Francesco; Francone, Marco; Tanzilli, Gaetano; Di Michele, Sara; Leonetti, Stefania; De Vincentis, Giuseppe; Carbone, Iacopo; Mangieri, Enrico; Catalano, Carlo; Passariello, Roberto

doi:10.1016/j.ijcard.2008.03.091

« Previous Next »International Journal of Cardiology
Volume 135, Issue 3 , Pages 280-286, 10 July 2009

Early detection of coronary artery disease by 64-slice multidetector computed tomography in asymptomatic hypertensive high-risk patients

Carlo Gaudio
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
- Corresponding author. Via Gregorio VII, n. 324, 00165 Roma, Italy. Tel.: +39 335 5219637; fax: +39 06 4453891.
Francesca Mirabelli
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
Francesco Pelliccia
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
Marco Francone
- Department of Radiological Sciences, University “La Sapienza” of Rome, Rome, Italy
Gaetano Tanzilli
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
Sara Di Michele
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
Stefania Leonetti
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
Giuseppe De Vincentis
- Department of Radiological Sciences, University “La Sapienza” of Rome, Rome, Italy
Iacopo Carbone
- Department of Radiological Sciences, University “La Sapienza” of Rome, Rome, Italy
Enrico Mangieri
- Department of Heart and Great Vessels “A. Reale”, University “La Sapienza” of Rome, Rome, Italy
Carlo Catalano
- Department of Radiological Sciences, University “La Sapienza” of Rome, Rome, Italy
Roberto Passariello
- Department of Radiological Sciences, University “La Sapienza” of Rome, Rome, Italy

Received 6 December 2007; received in revised form 28 February 2008; accepted 6 March 2008. published online 10 July 2008.

Abstract

Background

The 64-slice multidetector-row computed tomography (MDCT) is an accurate noninvasive technique for assessing the degree of luminal narrowing in coronary arteries of patients with chronic ischemic disease. Aim of this study was to determine the value of MDCT in comparison to invasive coronary angiography (ICA) for detecting the presence and extent of coronary atherosclerotic plaques in a population of asymptomatic, hypertensive patients considered to be at high risk for cardiovascular events.

Methods

We studied 67 asymptomatic, hypertensive patients at high-risk (Euro Score >5%). All patients had negative or nondiagnostic findings at exercise stress testing and therefore underwent both MDCT and ICA.

Results

In the per-patient analysis, MDCT correctly identified 16/17 (94%) patients with significant coronary artery disease involving at least 1 vessel and 48/50 (96%) normal subjects. In the per-segment analysis, MDCT correctly detected 21/22 (95%) coronary segments with a stenosis ≥50% and 856/868 (98%) normal segments, with a high negative predictivity of normal scans (100%). There was a good concordance between MDCT and ICA, with a high Pearson correlation coefficient between the coronary narrowings with the two techniques (r=0.84, p<0.01). Mean coronary calcium score was higher for the 17 patients with significant coronary artery disease on ICA than in the 50 patients without (422±223 HU vs 72±21 HU p<0.001). The ROC curves identified 160 as the best calcium volumetric score cut-off value able to identify ≥1 significant coronary stenosis with sensitivity 88% and specificity 85%.

Conclusions

MDCT is an excellent noninvasive technique for early identification of significant coronary stenoses in high risk asymptomatic hypertensive patients and might provide unique information for the screening of this broad population.

Keywords: Coronary angiography, Coronary artery disease, Multidetector computed tomography