Andreini Daniele, Pontone Gianluca, Pepi Mauro, Ballerini Giovanni, Bartorelli Antonio L, Magini Alessandra, Quaglia Carlo, Nobili Enrica, Agostoni Piergiuseppe
Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan, Milan, Italy.
J Am Coll Cardiol. 2007 May 22;49(20):2044-50. doi: 10.1016/j.jacc.2007.01.086. Epub 2007 May 4.
The purpose of this work was to assess the safety, feasibility, and diagnostic accuracy of multidetector computed tomography (MDCT) in dilated cardiomyopathy (DCM) of unknown etiology.
Multidetector computed tomography is an appropriate noninvasive tool for coronary artery disease (CAD) detection, particularly in patients with low probability of the disease, such as patients with DCM of unknown origin.
We studied 61 unknown origin DCM patients (ejection fraction: 33.9 +/- 8.6%, group 1) and 139 patients with normal cardiac function with indications for coronary angiography (group 2, control population). All underwent coronary MDCT and angiography. Multidetector computed tomography images were acquired by light speed 16-slice computed tomography. The degree of stenosis was estimated in 15 coronary artery segments according to the American Heart Association model.
In group 1, no MDCT-related complications were found, while 10 complications were associated with conventional angiography (p = 0.001). Overall feasibility of coronary artery visualization was 97.2% (863 of 888 segments). The most frequent cause of artifacts was interference from a hypertrophic cardiac venous system (10 artifacts, 40%). In group 2, overall feasibility was 96.1% (p = NS vs. group 1). In group 1, all cases with normal (44 cases) or pathological (17 cases) coronary arteries by conventional coronary angiography were correctly detected by MDCT, with, in 1 case, disparity of stenosis severity. In group 1, sensitivity, specificity, and positive and negative predictive values of MDCT for the identification of >50% stenosis were 99%, 96.2%, 81.2%, and 99.8%, respectively. In group 2, sensitivity and negative predictive values were lower than in group 1 (86.1% vs. 99% and 96.4% vs. 99.8%, respectively); specificity (96.4%) and positive predictive value (86.1%) were not significantly different versus group 1.
Multidetector computed tomography is feasible, safe, and accurate for identification of idiopathic versus ischemic DCM, and may represent an alternative to coronary angiography.
本研究旨在评估多排螺旋计算机断层扫描（MDCT）在病因不明的扩张型心肌病（DCM）中的安全性、可行性及诊断准确性。
多排螺旋计算机断层扫描是检测冠状动脉疾病（CAD）的一种合适的非侵入性工具，尤其适用于疾病发生概率较低的患者，如病因不明的DCM患者。
我们研究了61例病因不明的DCM患者（射血分数：33.9±8.6%，第1组）和139例有冠状动脉造影指征的心脏功能正常的患者（第2组，对照组）。所有患者均接受了冠状动脉MDCT及血管造影检查。多排螺旋计算机断层扫描图像由光速16层计算机断层扫描仪采集。根据美国心脏协会模型，对15个冠状动脉节段的狭窄程度进行评估。
在第1组中，未发现与MDCT相关的并发症，而10例并发症与传统血管造影有关（p = 0.001）。冠状动脉显影的总体可行性为97.2%（888个节段中的863个）。伪影最常见的原因是肥厚的心脏静脉系统的干扰（10处伪影，40%）。在第2组中，总体可行性为96.1%（与第1组相比，p =无显著性差异）。在第1组中，通过传统冠状动脉造影显示冠状动脉正常（44例）或病变（17例）的所有病例，MDCT均正确检测出，仅1例存在狭窄严重程度的差异。在第1组中，MDCT识别>50%狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为99%、96.2%、81.2%和99.8%。在第2组中，敏感性和阴性预测值低于第1组（分别为86.1%对99%和96.4%对99.8%）；特异性（96.4%）和阳性预测值（86.1%）与第1组相比无显著差异。
多排螺旋计算机断层扫描在鉴别特发性与缺血性DCM方面是可行、安全且准确的，可作为冠状动脉造影的替代方法。
