Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.
Eur J Radiol. 2011 Oct;80(1):120-6. doi: 10.1016/j.ejrad.2010.07.010. Epub 2010 Aug 12.
To prospectively determine the best cut-off value of stenosis degree for low-dose computed tomography coronary angiography (CTCA) to predict the hemodynamic significance of coronary artery stenoses compared to catheter angiography (CA) using a cardiac magnetic resonance based approach as standard of reference.
Fifty-two patients (mean age, 64±10 years) scheduled for CA underwent cardiac magnetic resonance (CMR) at 1.5-T and dual-source CTCA using prospective ECG-triggering the same day. Diagnostic performance of CTCA and CA to detect myocardial ischemia was evaluated with CMR as the standard of reference. The diagnostic performance and best cut-off values to predict the hemodynamic significance of coronary were determined from receiver operating characteristics analysis (ROC).
CA revealed >50% stenoses in 131/832 segments (15.7%) in 78/156 (50.0%) coronary arteries in 32/52 (62%) patients. CTCA revealed >50% stenoses in 148/807 (18.3%) segments, corresponding to 83/156 (53.2%) coronary arteries in 34/52 (65.4%) patients. CMR revealed ischemia in 118/832 (14.2%) myocardial segments corresponding to the territories of 60/156 (38.5%) coronary arteries in 29/52 (56%) patients. ROC analysis showed equal diagnostic performance for low-dose CTCA and CA with areas under the curve (AUC) of 0.82 and 0.83 (P=0.64). The optimal cut-off value was determined at stenosis of >60% for the prediction of hemodynamically significant coronary stenosis by CTCA. Using this cut-off value, sensitivity, specificity, NPV and PPV to predict hemodynamic significance by CTCA were 100%, 83%, 100%, and 88% on a per-patient basis and 88%, 73%, 83% and 81% on a per-artery analysis, respectively.
By considering coronary stenosis >60%, diagnostic performance for predicting the hemodynamic significance of coronary stenosis by CTCA is optimal and equals that of CA.
前瞻性确定低剂量计算机断层冠状动脉造影（CTCA）预测冠状动脉狭窄的血流动力学意义的最佳狭窄程度截断值，与以心脏磁共振为参考标准的导管血管造影（CA）相比。
52 例患者（平均年龄 64±10 岁），计划行 CA，同日于 1.5-T 行心脏磁共振（CMR）及双源 CTCA，采用前瞻性心电图触发。以 CMR 为标准，评估 CTCA 和 CA 检测心肌缺血的诊断性能。通过接受者操作特征分析（ROC）确定 CTCA 诊断性能和预测冠状动脉血流动力学意义的最佳截断值。
CA 在 78/156（50.0%）支冠状动脉的 32/52（62%）例患者中显示 832 个节段中有>50%狭窄。CTCA 在 807 个节段中有>50%狭窄，对应 156 个支冠状动脉中的 83 个（53.2%），在 52 个患者中的 34 个（65.4%）。CMR 在 29/52（56%）例患者中显示 118/832（14.2%）个心肌节段存在缺血，对应 156 个支冠状动脉中的 60 个（38.5%）。ROC 分析显示低剂量 CTCA 和 CA 的诊断性能相等，曲线下面积（AUC）分别为 0.82 和 0.83（P=0.64）。CTCA 预测血流动力学意义的最佳截断值为狭窄程度>60%。使用该截断值，CTCA 预测血流动力学意义的敏感性、特异性、阴性预测值和阳性预测值分别为 100%、83%、100%和 88%，基于患者的结果，88%、73%、83%和 81%，基于支冠状动脉的分析。
考虑冠状动脉狭窄程度>60%，CTCA 预测冠状动脉狭窄血流动力学意义的诊断性能最佳，与 CA 相当。
