PMID- 24011773
OWN - NLM
STAT- MEDLINE
DCOM- 20140602
LR  - 20220318
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 6
IP  - 10
DP  - 2013 Oct
TI  - CAD detection in patients with intermediate-high pre-test probability: low-dose 
      CT delayed enhancement detects ischemic myocardial scar with moderate accuracy 
      but does not improve performance of a stress-rest CT perfusion protocol.
PG  - 1062-1071
LID - S1936-878X(13)00538-X [pii]
LID - 10.1016/j.jcmg.2013.04.013 [doi]
AB  - OBJECTIVES: This study sought to compare computed tomography delayed enhancement 
      (CTDE) against cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) 
      for detection of ischemic scar and to test the additive value of CTDE as part of 
      a comprehensive multidetector computed tomography (MDCT) stress-rest protocol 
      including computed tomography perfusion (CTP) and computed tomography angiography 
      (CTA) for the diagnosis of significant coronary artery disease (CAD). BACKGROUND: 
      CTDE has been recently described as a promising tool for noninvasive detection of 
      myocardial scar, similarly to CMR-LGE techniques. Despite its theoretical 
      potential as an adjunctive tool to improve MDCT accuracy for detection of CAD, 
      its clinical performance has not been validated. METHODS: One hundred five 
      symptomatic patients with suspected CAD (age 62.0 +/- 8.0 years, 67% men) underwent 
      MDCT, CMR, and x-ray invasive coronary angiography. The MDCT protocol consisted 
      of calcium scoring, stress CTP under adenosine 140 mug/kg/min, rest CTP + CTA, and 
      a low-dose radiation prospective scan for detection of CTDE. CMR-LGE was used as 
      the reference standard for assessment of scar. Functionally significant CAD was 
      defined as the presence of >/=90% stenosis/occlusion or fractional flow reserve 
      measurements </=0.80 in vessels >2 mm. RESULTS: CTDE had good accuracy (90%) for 
      ischemic scar detection with low sensitivity (53%) but excellent specificity 
      (98%). Positive and negative predictive values were 82% and 91%, respectively. On 
      a patient-based model, MDCT protocol without integration of CTDE results had a 
      sensitivity, specificity, and positive and negative predictive values of 90%, 
      81%, 80%, and 90%, respectively, for the detection of functionally significant 
      CAD. Addition of CTDE results did not improve MDCT performance (90%, 77%, 77%, 
      and 90%, respectively). CONCLUSIONS: CTDE has moderate accuracy for detection of 
      ischemic scar in patients with suspected CAD. Integration of CTDE into a 
      comprehensive MDCT protocol including stress-rest CTP and CTA does not improve 
      MDCT accuracy for detection of significant CAD in intermediate-to-high pre-test 
      probability populations.
CI  - Copyright (c) 2013 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Bettencourt, Nuno
AU  - Bettencourt N
AD  - Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, 
      Portugal; Division of Imaging Sciences and Medical Engineering, King's College 
      London, London, United Kingdom; Cardiovascular R&D Unit, Faculty of Medicine, 
      University of Porto, Porto, Portugal. Electronic address: 
      bettencourt.n@gmail.com.
FAU - Ferreira, Nuno Dias
AU  - Ferreira ND
AD  - Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, 
      Portugal.
FAU - Leite, Daniel
AU  - Leite D
AD  - Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, 
      Portugal.
FAU - Carvalho, Monica
AU  - Carvalho M
AD  - Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, 
      Portugal.
FAU - Ferreira, Wilson da Silva
AU  - Ferreira WDS
AD  - Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, 
      Portugal.
FAU - Schuster, Andreas
AU  - Schuster A
AD  - Georg-August-University and German Center for Cardiovascular Research (DZHK, 
      Partner Site), Gottingen, Germany.
FAU - Chiribiri, Amedeo
AU  - Chiribiri A
AD  - Division of Imaging Sciences and Medical Engineering, King's College London, 
      London, United Kingdom.
FAU - Leite-Moreira, Adelino
AU  - Leite-Moreira A
AD  - Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, 
      Portugal.
FAU - Silva-Cardoso, Jose
AU  - Silva-Cardoso J
AD  - Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, 
      Portugal.
FAU - Nagel, Eike
AU  - Nagel E
AD  - Division of Imaging Sciences and Medical Engineering, King's College London, 
      London, United Kingdom.
FAU - Gama, Vasco
AU  - Gama V
AD  - Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, 
      Portugal.
LA  - eng
GR  - FS/10/029/28253/British Heart Foundation/United Kingdom
GR  - WT 088641/Z/09/Z/Wellcome Trust/United Kingdom
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130904
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Contrast Media)
RN  - 0 (Vasodilator Agents)
RN  - K72T3FS567 (Adenosine)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2013 Oct;6(10):1072-4. PMID: 24135321
MH  - *Adenosine
MH  - Adult
MH  - Aged
MH  - Cicatrix/*diagnosis/diagnostic imaging/pathology
MH  - Contrast Media
MH  - Coronary Angiography/*methods
MH  - Coronary Artery Disease/*diagnosis/diagnostic imaging/pathology/physiopathology
MH  - Female
MH  - Fractional Flow Reserve, Myocardial
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - *Multidetector Computed Tomography
MH  - Myocardial Ischemia/*diagnosis/diagnostic imaging/pathology/physiopathology
MH  - Myocardial Perfusion Imaging/*methods
MH  - Myocardium/pathology
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - *Radiation Dosage
MH  - Severity of Illness Index
MH  - *Vasodilator Agents
OTO - NOTNLM
OT  - CAD
OT  - CI
OT  - CMR
OT  - CTA
OT  - CTDE
OT  - CTP
OT  - FFR
OT  - LGE
OT  - MDCT
OT  - QCA
OT  - ROC
OT  - XA
OT  - cardiac magnetic resonance
OT  - computed tomography angiography
OT  - computed tomography delayed enhancement
OT  - computed tomography perfusion
OT  - confidence interval
OT  - coronary artery disease
OT  - delayed enhancement
OT  - fractional flow reserve
OT  - late gadolinium enhancement
OT  - multidetector computed tomography
OT  - quantitative coronary angiography
OT  - receiver-operating characteristic
OT  - tomography
OT  - x-ray invasive coronary angiography
EDAT- 2013/09/10 06:00
MHDA- 2014/06/03 06:00
CRDT- 2013/09/10 06:00
PHST- 2013/01/16 00:00 [received]
PHST- 2013/04/05 00:00 [revised]
PHST- 2013/04/12 00:00 [accepted]
PHST- 2013/09/10 06:00 [entrez]
PHST- 2013/09/10 06:00 [pubmed]
PHST- 2014/06/03 06:00 [medline]
AID - S1936-878X(13)00538-X [pii]
AID - 10.1016/j.jcmg.2013.04.013 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2013 Oct;6(10):1062-1071. doi: 
      10.1016/j.jcmg.2013.04.013. Epub 2013 Sep 4.