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- Title
Noninvasive detection of coronary vasospastic angina using a double-acquisition coronary CT angiography protocol in the presence and absence of an intravenous nitrate: a pilot study.
- Authors
Kang, Eun-Ju; Kim, Moo; Jin, Cai; Seo, Jeongmin; Kim, Dong; Yoon, Seong; Park, Tae-Ho; Lee, Ki-Nam; Choi, Sang; Yoon, Yeonyee; Kim, Moo Hyun; De Jin, Cai; Kim, Dong Won; Yoon, Seong Kuk; Choi, Sang Il; Yoon, Yeonyee Elizabeth
- Abstract
<bold>Objectives: </bold>To evaluate the feasibility of a double-acquisition coronary CT angiography (CCTA) protocol in the presence and absence of an intravenous (IV) vasodilator infusion for detecting vasospastic angina.<bold>Methods: </bold>Twenty patients with a high clinical probability of vasospastic angina were enrolled. All subjects underwent baseline CCTA without a vasodilator in the early morning followed by a catheterized coronary angiography with ergonovine provocation test. Within 3 days, all subjects underwent repeat CCTA during a continuous IV infusion of nitrate. Vasospastic angina as detected by CCTA was defined as significant stenosis (≥50 %) with negative remodelling without definite plaques or diffuse small diameter (<2 mm) of a major coronary artery with a beaded appearance on baseline CT that completely dilated on IV nitrate CT. The CCTA results were compared to the catheterized ergonovine provocation test as the reference standard.<bold>Results: </bold>Among 20 patients, the catheterized ergonovine provocation test detected vasospasm in 15 patients. The sensitivity, specificity, positive predictive value and negative predictive value of CCTA in a per-patient-based analysis were 73, 100, 100 and 56 %, respectively.<bold>Conclusions: </bold>Double-acquisition CCTA in the presence and absence of IV infusion of nitrate allows noninvasive detection of vasospastic angina with moderate sensitivity and high specificity.<bold>Key Points: </bold>• Limited data exist regarding the efficacy of CCTA in detecting vasospastic angina. • We propose a double-acquisition CCTA protocol with and without IV nitrate injections. • This protocol provides 100% specificity and moderate sensitivity (73%) in spasm detection.
- Subjects
COMPUTED tomography; ANGIOGRAPHY; VASODILATORS; STENOSIS; ERGOMETRINE; ANGINA pectoris; CORONARY arteries; CORONARY vasospasm; LONGITUDINAL method; PILOT projects; CORONARY angiography
- Publication
European Radiology, 2017, Vol 27, Issue 3, p1136
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-016-4476-2