Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents
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Citações na Scopus
25
Tipo de produção
article
Data de publicação
2011
Editora
ELSEVIER SCIENCE INC
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ISSN da Revista
Título do Volume
Autores
MOREIRA, Valeria de Melo
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Citação
JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, v.5, n.6, p.449-458, 2011
Resumo
BACKGROUND: Coronary computed tomography angiography (CTA) is a well-established diagnostic tool for coronary artery disease (CAD). However, coronary segments with prior stent implantation visualized with CIA may have limited evaluation and reduced accuracy. OBJECTIVE: We assessed the incremental value of stress myocardial CT perfusion (CTP) over anatomical assessment by coronary CIA alone in patients with stents, using quantitative invasive coronary angiography (>= 50%) as reference. METHODS: Forty-six patients (56.9 +/- 7.2 years; 28 men) referred to invasive coronary angiography were evaluated, combining coronary CIA and dipyridamole stress myocardial CTP with 64 detector-row CT. Coronary CTA was evaluated for >= 50% coronary stenosis, and myocardial CTP was used to potentially reclassify coronary territories, including those with stents and poorly evaluated stents because of artifacts. RESULTS: We evaluated 138 coronary territories, 62 with >= 1 stent. From these, 21(34%) territories had adequately evaluated stents, 28 (45%) had limitedly evaluated stents still allowing diagnosis, and 13 (21%) had inadequately evaluated stents (no luminal assessment possible). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for coronary CTA in stent territories were, respectively, 85%, 77%, 87%, 74%, and 81%, and the combined use of coronary CTA and myocardial CTP were 88%, 95%, 97%, 81%, and 91% (P = 0.0292). In territories with impaired stent evaluation (limited or inadequate), the diagnostic performance of coronary CIA alone was 83%, 72%, 79%, 76% and 77%, and combined with myocardial CTP were 87%, 94%, 95%, 85%, and 91% (P = 0.036). CONCLUSION: The combined evaluation of coronary CTA and stress myocardial CTP improved the diagnostic accuracy for the detection of significant obstructive CAD in patients with stents.
Palavras-chave
Coronary stents, Multidetector row computed tomography, Myocardial ischemia, Myocardial perfusion imaging, Dipyridamole
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