Sensitivity and specificity of assessing coronary bypass graft patency with ultrafast computed tomography: Results of a multicenter study

Abstract

Because a significant number of all patients seen by cardiologists have had coronary bypass surgery, a relatively noninvasive method of assessing coronary bypass graft patency would be very helpful. Ultrafast computed tomography, by virtue of its rapid data acquisition time and reasonable spatial resolution, may be useful in this regard. To determine the sensitivity, specificity and predictive accuracy of this imaging modality as compared with cardiac catheterization, a multicenter study was undertaken. There were two parts to the study. Part I involved the evaluation of 179 grafts in 74 patients studied in the five participating centers between March 1985 and August 1986. Twenty-nine percent of these graft studies were found to be technically inadequate and were excluded before patency determinations began. The remaining group of 127 bypass grafts in 62 patients had studies adequate for interpretation. Fifty-one grafts were to the left anterior descending coronary artery or a diagonal branch, 37 to branches of the left circumflex artery and 28 to the right coronary artery or a posterior descending vessel; in addition, there were 11 internal mammary artery bypass grafts primarily into the left anterior descending or diagonal artery distribution. The sensitivity of detecting angiographically open grafts was 93.4%, the specificity of detecting angiographically closed grafts 88.9% and the predictive accuracy was 92.1%. A subsequent study (Part 2) was performed 9 months later to assess the ability to carry out technically adequate examinations. Of the 138 consecutive graft examinations (50 patients) included in this part of the study, 94.2% of the examinations were found to be technically adequate.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of Coronary Artery Disease by Cardiac Computed Tomography

“…In most studies, the accuracy to detect bypass occlusion approached 100%. [211][212][213][214][215][216][217][218][219][220][221][222][223][224][225][226] Clinically, however, it might be reasonable in most cases to not only assess the patency of the bypass graft but also the presence of coronary stenoses in the course of the bypass graft or at the anastomotic site, as well as in the native coronary artery system (Class IIb, Level of Evidence: C). This is more difficult, owing to the smaller caliber of these vessels, the presence of artifacts caused by metal clips, and the often pronounced coronary calcification.…”

Noninvasive Detection of Coronary Artery Bypass Graft Patency by Intravenous Electron Beam Computed Tomographic Angiography.

“…However, in the early stage of these studies, EBCT was only used as a tool for time-density curves of bypass grafts rather than to produce two-or three-dimensional images of the lumen of a coronary artery bypass graft. 15,24,25) Achenbach, et al showed that the assessment of bypass graft patency using three-dimensional images (EBA) obtained with EBCT yielded an accuracy of 100% in 25 patients with 56 bypass grafts. 16) Ha, et al found the sensitivity and specificity of EBA in revealing LIMA patency were 80% and 82.4%, and the sensitivity and specificity of EBA in revealing SVG patency were 91.7% and 91.1%, respectively.…”

“…A multicenter study using planar tomographic imaging with EBCT attained fairly good diagnostic accuracy (the sensitivity, specificity, and accuracy of detecting graft patency were 93.4%, 88.9%, and 92.1%, respectively). 15) For the purpose of obtaining more detailed information to understand the anatomy and status of graft patency, [16][17][18] recent advances in EBA technology have offered the challenge of constructing a three-dimensional image of the cardiac surface with coronary vessels. In this technology, a series of image data should be sampled at a specified trigger-time point of the cardiac cycle for several heart beats.…”

TC multicorte (TCMC) cardiaca: aplicaciones clínicas

“…Posteriormente fueron varios los grupos de trabajo que investigaron la permeabilidad de los injertos aortocoronarios por TC [27][28][29][30] . En los primeros estudios se concluyó que debido a los artefactos por movimiento respiratorio y latido cardiaco, el estudio de TC únicamente podía dirigirse a valorar la permeabilidad de los injertos aortocoronarios ya que técnicamente existían grandes dificultades para determinar la existencia estenosis en los injertos permeables.…”