Purpose: Accurate non invasive screening is of primary importance in risk stratification of patients with low-intermediate pre test probability of Coronary heart disease (CHD). Exercise testing is a consolidated technique in the assessment of these patients however with a high rate of false positive to the test. The aim of our study is to assess the role of CA-MDCT in detecting significant disease in patients at low-moderate pre test probability. Methods and Materials: 170 consecutive patients studied between April 2008 and August 2010 with 64 slice CT (Brilliance 64, Philips, The Netherlands) at low (62/170) or moderate (108/170) CAD risk underwent exercise test and CA-MDCT. For each patient we evaluated the FRS score. Each patient was studied with treadmill test. On a per patient basis, lesions were judged as significant if lumen stenosis resulted >50%. All significant diseased patients revealed on CA-MDCT underwent CAG. Concordance between treadmill test and CA-MDCT was performed by means of Spearman test. CABG and 6 months follow-up was considered as the standard of reference. Results: 93/170 cases resulted positive at CA-MDCT while only 75/170 cases were positive at treadmill test. In 52 inconclusive treadmill tests CA-MDCT revealed the presence of significant lesions. Low correlation was found between FRS and CA-MDCT and between FRS and Treadmill test. Conclusion: CA-MDCT can better detect significant diseased patients than Treadmill test. CAD Risk stratification is better estimated by the use of CA-MDCT which is complementary to exercise test especially in cases of inconclusive test.
Coronary artery disease risk stratification: complementary role of coronary artery mdct to exercise test in patients with low-moderate pre test probability
MALAGO', Roberto;POZZI MUCELLI, Roberto
2011-01-01
Abstract
Purpose: Accurate non invasive screening is of primary importance in risk stratification of patients with low-intermediate pre test probability of Coronary heart disease (CHD). Exercise testing is a consolidated technique in the assessment of these patients however with a high rate of false positive to the test. The aim of our study is to assess the role of CA-MDCT in detecting significant disease in patients at low-moderate pre test probability. Methods and Materials: 170 consecutive patients studied between April 2008 and August 2010 with 64 slice CT (Brilliance 64, Philips, The Netherlands) at low (62/170) or moderate (108/170) CAD risk underwent exercise test and CA-MDCT. For each patient we evaluated the FRS score. Each patient was studied with treadmill test. On a per patient basis, lesions were judged as significant if lumen stenosis resulted >50%. All significant diseased patients revealed on CA-MDCT underwent CAG. Concordance between treadmill test and CA-MDCT was performed by means of Spearman test. CABG and 6 months follow-up was considered as the standard of reference. Results: 93/170 cases resulted positive at CA-MDCT while only 75/170 cases were positive at treadmill test. In 52 inconclusive treadmill tests CA-MDCT revealed the presence of significant lesions. Low correlation was found between FRS and CA-MDCT and between FRS and Treadmill test. Conclusion: CA-MDCT can better detect significant diseased patients than Treadmill test. CAD Risk stratification is better estimated by the use of CA-MDCT which is complementary to exercise test especially in cases of inconclusive test.
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