Department of Cardiology, Thorax Centre Rotterdam, The Netherlands.
Eur J Heart Fail. 2013 Sep;15(9):1028-34. doi: 10.1093/eurjhf/hft090. Epub 2013 Jun 12.
To evaluate the accuracy of cardiac computed tomography (CT) in distinguishing CAD and non-CAD heart failure (HF) and its effectiveness as a gatekeeper for invasive coronary angiography (ICA).
We prospectively included 93 symptomatic patients with newly diagnosed HF of unknown aetiology (59 men; mean age 53 ± 13) and EF <45%, and/or fractional shortening <25%, and/or end-diastolic LV diameter >60 mm (men) or >55 mm (women). In all patients, the CT calcium score (CTCS) was determined. CTCS = 0 excluded CAD HF. Additional CT coronary angiography (CTCA) was performed if CTCS >0. ICA was used as the gold standard for distinguishing between CAD and non-CAD HF in patients with >20% luminal diameter narrowing on CTCA. CAD HF was defined as >50% luminal diameter narrowing in either (i) the left main coronary artery or proximal left anterior descending coronary artery or (ii) in multiple coronary arteries. Diagnostic accuracy and follow-up data (20 ± 16 months) were collected for all patients. CTCS = 0 ruled out CAD HF in 43 patients (46%). The CT algorithm had 100% sensitivity, 95% specificity, 67% positive predictive value, and 100% negative predictive value for detecting CAD HF. Patients with CTCS = 0 or non-CAD HF on CTCA had no coronary events during follow-up, and ICA could have been safely avoided in 76 out of 93 patients (82%).
In patients with HF of unknown aetiology, cardiac CT combining CTCS and CTCA has high accuracy for detecting CAD HF and can be used effectively as a gatekeeper for ICA.
评估心脏计算机断层扫描（CT）在区分冠心病（CAD）和非 CAD 心力衰竭（HF）方面的准确性，并评估其作为有创冠状动脉造影（ICA）的筛选手段的有效性。
我们前瞻性纳入了 93 例病因不明的新发 HF 且射血分数（EF）<45%、或短轴缩短率<25%、或舒张末期左心室直径（男性）>60mm 或（女性）>55mm 的症状性患者。所有患者均行 CT 钙评分（CTCS）。CTCS=0 排除 CAD HF。如果 CTCS>0，则行 CT 冠状动脉造影（CTCA）。ICA 作为 CTCA 存在≥20%管腔狭窄的患者中区分 CAD 和非 CAD HF 的金标准。CAD HF 定义为左主干或近端左前降支或（ii）多支冠状动脉中≥50%的管腔狭窄。收集所有患者的诊断准确性和随访数据（20±16 个月）。CTCS=0 排除了 43 例（46%）CAD HF 患者。该 CT 算法检测 CAD HF 的敏感性为 100%，特异性为 95%，阳性预测值为 67%，阴性预测值为 100%。CTCS=0 或 CTCA 无 CAD HF 的患者在随访期间未发生冠状动脉事件，93 例患者中的 76 例（82%）可安全避免 ICA。
在病因不明的 HF 患者中，联合 CTCS 和 CTCA 的心脏 CT 对检测 CAD HF 具有较高的准确性，可有效作为 ICA 的筛选手段。
