Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardlomyopathy
Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardlomyopathy
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DOI：
10.1016/j.jacc.2007.01.086
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发表时间：
2007-05-22
影响因子：
24
通讯作者：
Agostoni, Piergiuseppe
中科院分区：
文献类型：
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作者：
Andreini, Daniele;Pontone, Gianluca;Agostoni, Piergiuseppe
目的探讨多排螺旋CT（MDCT）在诊断不明原因扩张型心肌病（DCM）中的安全性、可行性和准确性。方法我们研究了61例原因不明的DCM患者（射血分数：33.9 ± 8.6%，第1组）和139例心功能正常且有冠状动脉造影指征的患者（第2组，对照人群）。所有患者均接受了冠状动脉MDCT和血管造影。多探测器计算机断层扫描图像由光速16层计算机断层扫描获得。结果在第1组中，没有发现MDCT相关的并发症，而10例并发症与常规血管造影（P = 0.001）。冠状动脉可视化的总体可行性为97.2%（863/888个节段）。伪影最常见的原因是来自肥大心脏静脉系统的干扰（10个伪影，40%）。在第2组中，总体可行性为96.1%（p = NS vs.第1组）。第1组中，常规冠状动脉造影正常（44例）和病变（17例）的冠状动脉均被MDCT正确检出，其中1例狭窄程度不一致。在第1组中，MDCT识别>50%狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为99%、96.2%、81.2%和99.8%。第2组的敏感性和阴性预测值低于第1组（分别为86.1%对99%和96.4%对99.8%）特异性（96.4%）和阳性预测值结论多层螺旋CT对特发性和缺血性DCM的鉴别诊断是可行、安全、准确的，并且可以代表冠状动脉血管造影术的替代方案。
Objectives The purpose of this work was to assess the safety, feasibility, and diagnostic accuracy of multidetector computed tomography (MDCT) in dilated cardiomyopathy (DCM) of unknown etiology.Background Multidetector computed tomography is an appropriate noninvasive tool for coronary artery disease (CAD) detection, particularly in patients with low probability of the disease, such as patients with DCM of unknown origin.Methods We studied 61 unknown origin DCM patients (ejection fraction: 33.9 +/- 8.6%, group 1) and 139 patients with normal cardiac function with indications for coronary angiography (group 2, control population). All underwent coronary MDCT and angiography. Multidetector computed tomography images were acquired by light speed 16-slice computed tomography. The degree of stenosis was estimated in 15 coronary artery segments according to the American Heart Association model.Results In group 1, no MDCT-related complications were found, while 10 complications were associated with conventional angiography (p = 0.001). Overall feasibility of coronary artery visualization was 97.2% (863 of 888 segments). The most frequent cause of artifacts was interference from a hypertrophic cardiac venous system (10 artifacts, 40%). In group 2, overall feasibility was 96.1% (p = NS vs. group 1). In group 1, all cases with normal (44 cases) or pathological (17 cases) coronary arteries by conventional coronary angiography were correctly detected by MDCT, with, in 1 case, disparity of stenosis severity. In group 1, sensitivity, specificity, and positive and negative predictive values of MDCT for the identification of >50% stenosis were 99%, 96.2%, 81.2%, and 99.8%, respectively. In group 2, sensitivity and negative predictive values were lower than in group 1 (86.1% vs. 99% and 96.4% vs. 99.8%, respectively); specificity (96.4%) and positive predictive value (86.1%) were not significantly different versus group 1.Conclusions Multidetector computed tomography is feasible, safe, and accurate for identification of idiopathic versus ischemic DCM, and may represent an alternative to coronary angiography.