Diagnostic value of noninvasive comprehensive morphological and functional assessment of coronary artery disease

Zorica  Mladenovic; Ana Đorđević Dikić; Predrag Đurić; Anđelka  Angelkov Ristić; Boris Dzudović; Zoran Jovic

doi:10.2298/VSP170122069M

Zorica Mladenovic Clinic for Cardiology, Millitary Medical Academy
Ana Đorđević Dikić Clinical Centar of Serbia
Predrag Đurić Clinic for Cardiology, Millitary Medical Academy
Anđelka Angelkov Ristić Clinic for Urgent Medicine, Millitary Medical Academy
Boris Dzudović
Zoran Jovic

DOI: https://doi.org/10.2298/VSP170122069M

Keywords: coronary artery disease, diagnosis, differential, blood flow velocity, echocardiography, doppler, multidetector computed tomography, coronary angiography, sensitivity and specificity

Abstract

Abstract

Background/Aim. Recently adopted technique, Transthoracic Doppler Echocardiography (TDE) enables the estimate of functional significance of coronary luminal narrowing. A multi-slice computed coronary angiography (MSCT), as one of the most important noninvasive methods, offers us a quite precise visualization of morphological characteristics of atherosclerotic changes in coronary arteries. We have tried to evaluate the most reliable noninvasive approach aimed at the detection of major stenosis on the left anterior descending artery (LAD) and the right coronary artery (RCA). Methods. This study involved 84 patients, with the previously detected atherosclerotic lesions on the LAD and/or RCA by MSCT. The coronary flow reserve (CFR) assessment by TDE with adenosine was obtained in LAD (n = 75); RCA (n = 61), resulting in 136 vessels subjected to the analysis. Invasive coronary angiography (ICA) was performed in all patients within 24 to 48 hours after the CFR as a reference technique. Results. The Cochrans Q test proved a significant statistical difference among these techniques in detection of a significant stenosis on the LAD and RCA (p < 0.01). Further analyses revealed a significant difference between the MSCT and CFR (p < 0.05), MSCT and ICA (p < 0.01), whereas we did not find a significant difference between the CFR and ICA (p > 0.05). The main discrepancies in results among the CFR, ICA and MSCT were noticed concerning intermediate and severe stenosis on the MSCT. The MSCT had a diagnostic accuracy for the LAD 66.67%, for the RCA 75.%, the CFR had for the LAD 90% and for the RCA 81.67%, in detection of significant stenosis. Where the consensus was reached between both techniques, diagnostic accuracy was improved for the LAD 97.33% and the RCA 90 %. Conclusion. Comprehensive noninvasive evaluation of both anatomical and functional imaging in coronary diseases makes the optimal approach for precise, noninvasive assessment of the coronary artery lesions in the coronary arteries.

References

REFERENCES

Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coro-nary computed tomographic angiography for evaluation of co-ronary artery stenosis in individuals without known coronary artery disease: Results from the prospective multicenter AC-CURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008; 52(21): 1724–32.

Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008; 359(22): 2324–36.

Vanhoenacker PK, Heijenbrok-Kal MH, van Heste R, Decramer I, van Hoe LR, Wijns W, et al. Diagnostic performance of multi-detector CT angiography for assessment of coronary artery disease: Meta-analysis. Radiology 2007; 244(2): 419–28.

Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 2005; 46(3): 552–7.

Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: A comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005; 46(1): 147–54.

Mollet NR, Cademartiri F, Mieghem CA, Runza G, McFadden EP, Baks T, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 2005; 112(15): 2318–23.

Fine JJ, Hopkins CB, Ruff N, Newton CF. Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease. Am J Cardiol 2006; 97(2): 173–4.

Carli MF, Dorbala S, Curillova Z, Kwong RJ, Goldhaber SZ, Rybicki FJ, et al. Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging. J Nucl Cardiol 2007; 14: 799–809.

Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 1994; 330(25): 1782–8.

Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascu-lar Surgery, American Heart Association. Circulation1975; 51(4 Suppl): 5–40.

Cademartiri F, Schuijf JD, Pugliese F, Mollet NR, Jukema JW, Maffei E, et al. Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis. J Am Coll Cardiol 2007; 49(22): 2204–10.

Schuijf JD, Wijns W, Jukema JW, Atsma DE, Roos A, de Lamb HJ, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006; 48(12): 2508–14.

Gaemperli O, Schepis T, Koepfli P, Valenta I, Soyka J, Leschka S, et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myo-cardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2007; 34(8): 1162–71.

Hacker M, Jakobs T, Hack N, Nikolaou K, Becker C, von Ziegler F, et al. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging 2007; 34(1): 4–10.

Meijboom WB, van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, et al. Comprehensive assessment of coronary ar-tery stenoses: Computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 2008; 52: 636–43.

van Werkhoven JM, Schuijf JD, Jukema JW, Pundziute G, de Roos A, Schalij MJ, et al. Comparison of non-invasive multi-slice computed tomography coronary angiography versus invasive coronary angiography and fractional flow reserve for the evaluation of men with known coronary artery disease. Am J Cardiol 2009; 104(5): 653–6.

Mladenovic Z, Djordjevic-Dikic A, Tavciovski D, Angelkov AR, Jovic Z, Djuric P. The additive diagnostic role of coronary flow re-serve in noninvasive evaluation of coronary stenosis on left descending artery previously detected by multislice computed tomography. Echocardiography 2013; 30(3): 338–44.

Nissen SE. Limitations of computed tomography coronary an-giography. J Am Coll Cardiol 2008; 52(25): 2145–7. An alter-native to nuclear perfusion imaging?. Heart 2008; 94(3): 255–7.

Schuijf JD, Bax JJ. CT angiography: an alternative to nuclear perfusion imaging? Heart 2008; 94(3): 255–7.

Hamon M, Biondi-Zoccai GG, Malagutti P, Agostoni P, Morello R, Valgimigli M. Diagnostic performance of multislice spiral com-puted tomography of coronary arteries as compared with con-ventional invasive coronary angiography: A meta-analysis. J Am Coll Cardiol 2006; 48(9): 1896–910.

Pizzuto F, Voci P, Bartolomucci F, Puddu PE, Strippoli G, Broglia L, et al. Usefulness of coronary flow reserve measured by echocardiography to improve the identification of significant left anterior descending coronary artery stenosis assessed by multidetector computed tomography. Am J Cardiol 2009; 104(5): 657–64.

Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, Dragu R, et al. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assess-ment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol 2007; 49: 1059–67.

Meimoun P, Tribouilloy C. Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: A magic tool for the real world. Eur J Echocardiogr 2008; 9(4): 449–57.

Caiati C, Montaldo C, Zedda N, Ruscazio M, Lai G, Cadeddu M, et al. Validation of a non-invasive method (contrast enhanced transthoracic second harmonic echo Doppler) for the evalua-tion of coronary flow reserve: Comparison with intracoronary Doppler flow wire. J Am Coll Cardiol 1999; 34(4): 1193–200.

Lethen H, Tries HP, Brechtken J, Kersting S, Lambertz H. Comparison of transthoracic Doppler echocardiography to intracoronary Doppler guidewire measurements for assessment of coronary flow reserve in the left anterior descending artery for detection of restenosis after coronary angioplasty. Am J Cardiol 2003; 91(4): 412–7.

Lethen H, Tries HP, Kersting S, Lambertz H. Validation of non-invasive assessment of coronary flow velocity reserve in the right coronary artery. A comparison of transthoracic echocar-diographic results with intracoronary Doppler flow wire mea-surements. Eur Heart J 2003; 24(17): 1567–75.

Ueno Y, Nakamura Y, Takashima H, Kinoshita M, Soma A. Non-invasive assessment of coronary flow velocity and coronary flow velocity reserve in the right coronary artery by transtho-racic Doppler echocardiography: Comparison with intracoro-nary Doppler guidewire. J Am Soc Echocardiogr 2002; 15(10 Pt 1): 1074–9.