Funabashi Nobusada, Uehara Masae, Takaoka Hiroyuki, Ozawa Koya, Kushida Shunichi, Kanda Junji, Fujimoto Yoshihide, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
Int J Cardiol. 2014 Dec 15;177(2):374-9. doi: 10.1016/j.ijcard.2014.07.126. Epub 2014 Aug 27.
To compare diagnostic-accuracy of prospective and retrospective-ECG-gated acquisition in 320-slice-CT for detecting coronary-artery stenosis in subjects with chronic-atrial-fibrillation (CAF) in a two-center study.
53 CAF subjects who underwent 320-slice-CT, and invasive-coronary-angiogram (ICA) within 6-months (43 male; 69 ± 9 years; CHADS2 score 2.2 ± 1.3; CHA2DS2-VASc score 3.5 ± 1.6) in the two institutes were analyzed. In Institute-1, prospective-ECG-gated acquisition was routinely performed (N=33). In Institute-2, retrospective-ECG-gated acquisition was routinely performed (N=20). CT and ICA data were transferred to the analysis center and were analyzed by cardiologists blinded to the clinical-data.
Prevalence of >50 and >75% on ICA was 79 and 61% in Institute-1, and 30 and 15% in Institute-2, respectively. In a patient-by-patient analysis, Institute-2 had higher negative-predictive-value (NPV) and accuracy of >75% stenosis on CT in predicting >75% stenosis on ICA. In a vessel-by-vessel analysis, there were no significant-differences of sensitivity, specificity, positive-predictive-value (PPV) and NPV of >50% stenosis on CT in predicting >50% stenosis on ICA between both institutes. But sensitivity, specificity, and NPV of >75% stenosis on CT in predicting >75% stenosis on ICA were significantly higher in Institute-2 than in Institute-1. This is mainly because of more severe coronary-artery disease including calcification in Institute-1; there might also have been an influence of differences in scanning and reconstruction methods.
320-slice-CT shows relatively high diagnostic-accuracy for the detection of significant coronary-artery stenosis compared with ICA even in CAF subjects, in a two-center analysis. Retrospective-ECG-gated acquisition in 320-slice-CT shows significantly higher diagnostic-accuracy than prospective-ECG-gated acquisition for detection of >75% coronary-artery stenosis.
在一项双中心研究中，比较320层CT前瞻性和回顾性心电图门控采集对检测慢性心房颤动（CAF）患者冠状动脉狭窄的诊断准确性。
分析了53例在两家机构6个月内接受320层CT和有创冠状动脉造影（ICA）检查的CAF患者（43例男性；年龄69±9岁；CHADS2评分2.2±1.3；CHA2DS2-VASc评分3.5±1.6）。在机构1，常规进行前瞻性心电图门控采集（N=33）。在机构2，常规进行回顾性心电图门控采集（N=20）。CT和ICA数据被传输到分析中心，由对临床数据不知情的心脏病专家进行分析。
机构1中ICA上>50%和>75%狭窄的患病率分别为79%和61%，机构2中分别为30%和15%。在逐患者分析中，机构2在CT上>75%狭窄预测ICA上>75%狭窄方面具有更高的阴性预测值（NPV）和准确性。在逐血管分析中，两家机构在CT上>50%狭窄预测ICA上>50%狭窄的敏感性、特异性、阳性预测值（PPV）和NPV方面没有显著差异。但机构2中CT上>75%狭窄预测ICA上>75%狭窄的敏感性、特异性和NPV显著高于机构1。这主要是因为机构1中包括钙化在内的冠状动脉疾病更严重；扫描和重建方法的差异可能也有影响。
在双中心分析中，即使在CAF患者中，与ICA相比，320层CT对检测显著冠状动脉狭窄也显示出相对较高的诊断准确性。320层CT回顾性心电图门控采集在检测>75%冠状动脉狭窄方面显示出比前瞻性心电图门控采集显著更高的诊断准确性。
