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Diagnostic accuracy of coronary CT angiography performed by the novel whole organ volumetric high definition CT scanner in patients with atrial fibrillation

Session CT and nuclear imaging: new clinical frontiers

Speaker Edoardo Conte

Event : ESC Congress 2016

  • Topic : imaging
  • Sub-topic : Computed Tomography
  • Session type : Rapid Fire Abstracts

Authors : S Mushtaq (Milan,IT), E Conte (Milan,IT), M Guglielmo (Milan,IT), A Baggiano (Milan,IT), V Volpato (Milan,IT), C Agalbato (Milan,IT), V Beltrama (Milan,IT), E Mancini (Milan,IT), A Formenti (Milan,IT), A Annoni (Milan,IT), AL Bartorelli (Milan,IT), C Fiorentini (Milan,IT), M Pepi (Milan,IT), G Pontone (Milan,IT), D Andreini (Milan,IT)

Authors:
S. Mushtaq1 , E. Conte1 , M. Guglielmo1 , A. Baggiano1 , V. Volpato1 , C. Agalbato1 , V. Beltrama1 , E. Mancini1 , A. Formenti1 , A. Annoni1 , A.L. Bartorelli2 , C. Fiorentini2 , M. Pepi1 , G. Pontone1 , D. Andreini2 , 1Cardiology Center Monzino IRCCS - Milan - Italy , 2University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dept. of Cardiology - Milan - Italy ,

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 1027

Objectives: To evaluate the image quality, coronary interpretability, radiation exposure and diagnostic accuracy of coronary CT angiography (CCTA) performed with a newest generation of cardiac-CT scanner in patients with atrial fibrillation (AF).

Background: Despite the relevant improvement in the CT temporal resolution that characterizes the last scanner generation, the evaluation of coronary arteries by CCTA in patients with AF remains the more challenging application of cardiac-CT and the radiation exposure is still very high in this clinical subset. Particularly, previous data on CCTA diagnostic accuracy are very limited.

Materials and methods: 82 patients (55 males, mean age 72±8 years old) with chronic AF and indication for elective invasive coronary angiography (ICA). CCTA were performed using a novel whole organ volumetric high definition CT scanner (16cm z-axis coverage with 256 detector rows and 512 slices, gantry rotation time 0.28 sec). Prospective ECG-triggering was used in all patients. Image quality score (by a 4-point Likert scale on a per-segment level), coronary interpretability, effective dose (ED) and diagnostic accuracy vs. ICA were evaluated.

Results: The pre-test probability of CAD was intermediate (53%). The mean HR during the scan was 83±21 bpm. The overall image quality was high (Likert=3.24±1.1, excellent image quality=589 segments, good=467 segments, adequate=234 segments, poor/non diagnostic=20 segments). In a segment-based model, the coronary interpretability was 98.4% (1290/1310 segments). The mean effective dose was 3.9±2 mSv. In a segment-based analysis, using evaluable segments for the analysis only, sensitivity, specificity, positive predictive value, negative predictive value and accuracy for >50% coronary stenosis identification vs. ICA were 96.7%, 99.6%, 96.7%, 99.6% and 99.3%, respectively. In a segment-based analysis, using all segments for the analysis, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 96.8%, 98.6%, 88.4%, 99.6% and 98.4%, respectively. In a patient-based analysis, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 94.3%, 100%, 100%, 95.8% and 97.5%, respectively.

Conclusions: The novel whole organ high definition CT scanner allows to evaluate coronary arteries with high image quality, low radiation exposure and excellent diagnostic accuracy in patients with atrial fibrillation and high HR during the scan.

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