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Sixty-four slice CT spiral coronary angiography does not predict down-stream hemodynamic effects of epicardial lesions in patients with ischemic cardiomyopathy

¹ Internal Medicine, Nuclear Cardiology and Cardiovascular Center, Geneva, Geneva, Switzerland; ² Radiology and Medical Informatics, Nuclear Medicine, Geneva, Switzerland

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Objectives: To evaluate spiral multidetector computed tomography (MDCT) angiography using 64-slice technique in the detection of flow-limiting epicardial stenosis in patients with ischemic cardiomyopathy.

Methods: 27 patients with ischemic cardiomyopathy (LVEF:32±12%) were investigated. Myocardial perfusion was evaluated with 201thallium-SPECT and myocardial viability with FDG–PET. Myocardial regions with fixed hypoperfusion at rest and during stress, but with viable myocardium ("mismatch"), were defined as fixed "ischemic" perfusion defects. Conversely, a reversible perfusion defect on gated SPECT images was indicative of a ischemic perfusion defect during stress. Focal epicardial lesions with luminal narrowing of 50% were defined as "significant" both on MDCT angiography and coronary angiography (CA).

Results: Based on a vessel- and patient-analysis, the sensitivity, specificity, negative and positive predictive values (NPV and PPV), and diagnostic accuracy of MDCT angiography in identifying regional myocardial ischemia were 70%, 88%, 88%, 70%, 83% and 83%, 25%, 33%, 77%, 68%, respectively. If epicardial lesions 50% on CA were considered, the sensitivity, specificity, NPV, PPV and accuracy to identify ischemic regions were, respectively, 63%, 85%, 83%, 63%, 82%, and 77%, 100%, 57%, 100%, 82% for a vessel- and patient- based analysis.

Conclusions: In patients with ischemic cardiomyopathy, sixty-four slice MDCT angiography demonstrates a relative low negative predictive value in the exclusion of flow-limiting epicardial lesions, while the prediction of hemodynamic consequences of focal epicardial lesions appears to be moderate.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Nkoulou, R. Articles by Schindler, T. PubMed Articles by Nkoulou, R. Articles by Schindler, T.