Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease

Budoff, Matthew J.; Dowe, David A.; Jollis, James G.; Gitter, Michael J.; Sutherland, John M.; Halamert, Edward; Scherer, M; Bellinger, Raye L.; Martin, A; Benton, Robert; Delago, Augustin; Min, James K.

doi:10.1016/j.jacc.2008.07.031

Cited by 1,878 publications

(477 citation statements)

References 20 publications

Supporting

Mentioning

418

Contrasting

Unclassified

Order By: Relevance

“…It is a surprising finding that among the patients who had CCTA, only 54% were found to have obstructive CAD during invasive coronary angiography. This is certainly disparate to the findings of many who have shown the very high diagnostic accuracy of CCTA6, 7 for the detection of obstructive CAD and begs the question of who got invasive coronary angiography and who did not and the reasons for these evaluations. It is also surprising that stress echocardiography and stress single‐photon emission computed tomography myocardial perfusion imaging did not demonstrate higher diagnostic accuracy than GXT, which is very much in conflict with the existing literature 8, 9, 10.…”

mentioning

confidence: 72%

Initial Diagnostic Evaluation of Stable Coronary Artery Disease: The Need for a Patient‐Centered Strategy

Hendel

Jabbar

Mahata

2017

JAHA

View full text Add to dashboard Cite

mentioning

confidence: 72%

Initial Diagnostic Evaluation of Stable Coronary Artery Disease: The Need for a Patient‐Centered Strategy

Hendel

Jabbar

Mahata

2017

JAHA

View full text Add to dashboard Cite

“…This observational evidence has now been corroborated by 2 multicenter clinical trials of the diagnostic accuracy of CCTA (26,27). In the former trial (26), 230 patients underwent CCTA and invasive coronary angiography (59% men; mean age, 57 y).…”

Section: Multicenter Clinical Trials With Cctamentioning

confidence: 84%

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Shaw

Narula²

2009

J Nucl Med

View full text Add to dashboard Cite

This review highlights and compares risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and coronary CT angiography (CCTA). This review highlights an expansive evidence base for stress myocardial perfusion imaging and reveals a decided advantage for higher-risk patients, notably those who have established coronary artery disease (CAD). It is likely that the use of CCTA will continue to expand, particularly for patients with more atypical symptoms and patients with a lower likelihood of CAD. Despite a high level of evidence, comparative research is not available across modalities that could definitively drive utilization of cardiac imaging modalities. Evi dence about the accuracy of a variety of noninvasive imaging tests for the identification of at-risk patients with known and suspected coronary artery disease (CAD) has been evolving. Most of the early published research on noninvasive cardiology, from the 1980s and early 1990s, focused on the diagnostic accuracy of a test. More recent research has focused on evaluating the ensuing risk in patients with normal and abnormal cardiac imaging findings. Further exploration has been aimed at the graded or directly proportional relationships between the extent and the severity of imaging risk markers and major adverse cardiovascular events. These relationships highlight a common theme throughout the literature of ever-increasing and worsening cardiac event risk with more extensive and severe imaging abnormalities. More recent topics in the prognosis literature are the utility of new technology, such as coronary CT angiography (CCTA), and its accuracy compared with that of conventional testing, such as stress nuclear imaging. For this report, we compare risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and CCTA. We further highlight the potential value of hybrid imaging with PET/CT or even sequential imaging with SPECT plus CT. CORRELATION BETWEEN MYOCARDIAL ISCHEMIA AND CORONARY ANATOMYEarly research focused on the accuracy of stress nuclear imaging for detecting obstructive coronary stenosis. Lessons learned from these evaluations were that the detection of obstructive stenosis was related to the severity of the stenosis, collateral flow, and underlying endothelial function. Documentation of high rates of false-positive results (i.e., ischemia with no obstructive CAD) with stress myocardial perfusion may be related to vascular dysfunction, an early marker of atherosclerosis. In addition, normal stress perfusion results in patients with CAD are related to many factors, including collateral blood flow or prior coronary revascularization. It is for these reasons that much of the recent imaging research has focused on risk determination. However, for discussion purposes, it is helpful to understand the relationship between ischemia and coronary anatomy. INDUCIBLE ISCHEMIA D...

show abstract

“…[4] It has been demonstrated in large studies that CCT has a very high sensitivity for obstructive CAD, allowing non-invasive assessment with a negative predictive value that often exceeds 99% compared with invasive angiography. [9] Therefore, CCT provides the unique ability to effectively rule out obstructive CAD as an important etiology for VT. Furthermore, patients who initially undergo CCT to rule out CAD may later be evaluated for other structural etiologies of VT without the need for further re-imaging.…”

Section: Ischemic Cardiomyopathy/obstructivementioning

confidence: 99%

“…[7,8] As further advances in CT imaging technology are made, cardiac computed tomography (CCT) has an increasing number of emerging applications beyond its recognized utility as a noninvasive diagnostic tool for imaging coronary arteries and assessing CAD. [9] In particular, CCT has demonstrated its usefulness in identifying structural intracardiac pathology and measuring parameters of cardiac anatomy and function. As such, CCT has potential for helping identify myocardial substrate in patients who present with VT/SCD, or for identifying patients who are at risk for developing these substrates.…”

Section: Introductionmentioning

confidence: 99%

Utility of cardiac computed tomography to identify arrhythmia substrates for ventricular tachycardia and sudden cardiac death

Lee

Budoff

Girsky

2016

JBGC

View full text Add to dashboard Cite

Sudden cardiac death (SCD) is the leading cause of death in the U.S., and many of these events are attributable to malignant ventricular arrhythmias such as sustained ventricular tachycardia (VT). Most of the efforts to identify arrhythmia precipitants in these patients are based on imaging to look for myocardial or coronary artery disease. As advances in cardiac computed tomography (CCT) are made, it has demonstrated its usefulness in identifying structural intracardiac pathology and measuring parameters of cardiac anatomy and function. In this article we review the different etiologies of VT/SCD that are identifiable by CCT, and its potential usefulness in the workup for VT/SCD.

show abstract

Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease

Cited by 1,878 publications

References 20 publications

Initial Diagnostic Evaluation of Stable Coronary Artery Disease: The Need for a Patient‐Centered Strategy

Initial Diagnostic Evaluation of Stable Coronary Artery Disease: The Need for a Patient‐Centered Strategy

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Utility of cardiac computed tomography to identify arrhythmia substrates for ventricular tachycardia and sudden cardiac death

Contact Info

Product

Resources

About