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Vogelgesang F, Coenen MH, Schueler S, Schlattmann P, Dewey M. An exemplary reanalysis of coronary computed tomography angiography diagnostic meta-analyses shows insufficient data sharing and incorrect sensitivity and specificity estimates. J Clin Epidemiol 2024; 170:111306. [PMID: 38428541 DOI: 10.1016/j.jclinepi.2024.111306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To systematically evaluate the reproducibility of primary data and, the reproducibility and correctness of pooled sensitivity and specificity estimates reported in a sample of diagnostic meta-analyses. STUDY DESIGN AND SETTING We conducted an exemplary systematic review of diagnostic meta-analyses comparing coronary computed tomography angiography to invasive coronary angiography in patients with suspected coronary artery disease. The objectives were to assess 1) the reproducibility of contingency tables, 2) the reproducibility of pooled sensitivity and specificity, and 3) differences to reported results when applying a recommended bivariate binomial model for pooling sensitivity and specificity. Therefore, we reproduced the contingency tables and recalculated sensitivity and specificity by utilizing both the pooling method of each meta-analysis and a bivariate binomial model. We used linear trends to assess the improvement of these objectives over time. RESULTS We identified 38 diagnostic meta-analyses, each including on average 19 primary studies (range: 3 to 89 studies; total: 715-including duplicates) with an average of approximately 1800 patients per meta-analysis (range: 118 to 7516 patients). For 31 meta-analyses (82%, 95% CI: 65%, 91%), the contingency tables were reproducible; however, only 15 published them. Using the pooling method of each meta-analysis, we obtained comparable recalculated sensitivities/specificities for 28 meta-analyses (74% [57%, 86%]). Only 11 meta-analyses pooled sensitivity/specificity using a bivariate binomial model (29% [16%, 46%]). When all meta-analyses were pooled with this model, published sensitivities/specificities were confirmed for 19 of 38 meta-analyses (50% [34%, 66%]). There was only marginal improvement in data availability and application of recommended pooling methods over time. CONCLUSION Data sharing should become standard practice along with the use of appropriate pooling methods. Journal publication requirements may play a key role in enhancing the quality of scientific reporting and methodological standards which may lead to more reliable and consistent outcomes. The ability to reproduce sensitivity and specificity estimates in diagnostic imaging meta-analyses is dependent on the availability of contingency tables and the explicit reporting of pooling methods and software used.
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Affiliation(s)
- Felicitas Vogelgesang
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maria H Coenen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Schueler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health and Berlin University Alliance, Berlin, Germany.
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Mander GT, Dobeli K, Steffensen C, Munn Z. Diagnostic accuracy of prospectively gated, 128-slice or greater CTCA at high heart rates: a systematic review and meta-analysis. J Med Radiat Sci 2021; 68:435-445. [PMID: 34235885 PMCID: PMC8656183 DOI: 10.1002/jmrs.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Prospectively gated 64-slice CT coronary angiography (CTCA) may be contraindicated for heart rates (HRs) over 65 beats per minute (bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically provide 128 or more slices and superior temporal resolution compared with older models; consequently, diagnostic accuracy for current technology prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of this systematic review was to investigate the diagnostic accuracy of CTCA using 128-slice or greater CT technology when compared with conventional coronary angiography for patients with HRs >65 bpm. METHODS A systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as well as unpublished databases, sources and reference lists. Titles and abstracts were screened by two independent reviewers. Full-text screening was then performed. Studies that determined diagnostic accuracy of coronary artery stenosis in adult patients with high heart rates utilising prospectively gated 128 detector or greater scanners were included. Studies that were included in the review underwent critical appraisal using the QUADAS-2 tool. RESULTS Ten studies were included in the systematic review, with nine of these included in a diagnostic test accuracy meta-analysis, including six of which reported data at the patient level. Meta-analysis indicated very high pooled sensitivity 100% (95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI 0.69, 0.88). CONCLUSIONS Prospectively gated CT coronary angiography may be justifiable at heart rates above 65 bpm if performed on a 128-slice or greater CT unit. Caution regarding the implication of a positive result is recommended due to reduced specificity. Further evidence is required before consideration of a new higher heart threshold.
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Affiliation(s)
- Gordon T.W. Mander
- Toowoomba HospitalDarling Downs HealthQueensland HealthToowoombaQueenslandAustralia
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Karen Dobeli
- Royal Brisbane and Women’s HospitalMetro North Hospital and Health ServiceQueensland HealthHerstonQueenslandAustralia
| | - Caitlin Steffensen
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Philips Australia and New ZealandBrisbaneQueenslandAustralia
| | - Zachary Munn
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Coronary Computed Tomography Angiography for Assesment of Stable Coronary Artery Disease – a Cost-effectiveness Perspective. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Patients with chest pain presenting to the emergency room are currently investigated using either invasive coronary angiography (ICA) or noninvasive coronary computed tomography angiography (CCTA). ICA remains an expensive diagnostic tool and exposes patients to a high risk of periprocedural complication. Besides the currently available expansive economic evidence, there is still an important lingering issue: to establish, from the healthcare provider’s point of view, which is the most cost-effective investigation tool for the detection of significant coronary artery disease. The aim of this article is to present the latest developments in the field of imaging tools for the detection of coronary atherosclerosis in patients with chest pain, from the perspective of a cost-effectiveness analysis.
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Mancini GBJ, Leipsic J, Budoff MJ, Hague CJ, Min JK, Stevens SR, Reynolds HR, O'Brien SM, Shaw LJ, Manjunath CN, Mavromatis K, Demkow M, Lopez-Sendon JL, Chernavskiy AM, Gosselin G, Schuchlenz H, Devlin GP, Chauhan A, Bangalore S, Hochman JS, Maron DJ. CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging 2021; 14:1384-1393. [PMID: 33454249 DOI: 10.1016/j.jcmg.2020.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to examine the concordance of coronary computed tomographic angiography (CCTA) assessment of coronary anatomy and invasive coronary angiography (ICA) as the reference standard in patients enrolled in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches). BACKGROUND Performance of CCTA compared with ICA has not been assessed in patients with very high burdens of stress-induced ischemia and a high likelihood of anatomically significant coronary artery disease (CAD). A blinded CCTA was performed after enrollment to exclude patients with left main (LM) disease or no obstructive CAD before randomization to an initial conservative or invasive strategy, the latter guided by ICA and optimal revascularization. METHODS Rates of concordance were calculated on a per-patient basis in patients randomized to the invasive strategy. Anatomic significance was defined as ≥50% diameter stenosis (DS) for both modalities. Sensitivity analyses using a threshold of ≥70% DS for CCTA or considering only CCTA images of good-to-excellent quality were performed. RESULTS In 1,728 patients identified by CCTA as having no LM disease ≥50% and at least single-vessel CAD, ICA confirmed 97.1% without LM disease ≥50%, 92.2% with at least single-vessel CAD and no LM disease ≥50%, and only 4.9% without anatomically significant CAD. Results using a ≥70% DS threshold or only CCTA of good-to-excellent quality showed similar overall performance. CONCLUSIONS CCTA before randomization in ISCHEMIA demonstrated high concordance with subsequent ICA for identification of patients with angiographically significant disease without LM disease.
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Affiliation(s)
- G B John Mancini
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jonathan Leipsic
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cameron J Hague
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; St. Paul's Hospital Department of Radiology, Vancouver, British Columbia, Canada
| | | | | | - Harmony R Reynolds
- New York University Grossman School of Medicine, New York, New York, USA
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | | | | | | | - Alexander M Chernavskiy
- E.Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | | | - Herwig Schuchlenz
- LKH Graz II, Department fuer Kardiologie und Intensivmedizin, Graz, Austria
| | | | - Anoop Chauhan
- Blackpool Teaching Hospitals, Lancashire, United Kingdom
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, New York, USA
| | - Judith S Hochman
- New York University Grossman School of Medicine, New York, New York, USA
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Radiological outpatient' visits to avoid inappropriate cardiac CT examinations: an 8-year experience report. Radiol Med 2020; 126:214-220. [PMID: 32651776 DOI: 10.1007/s11547-020-01246-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate the appropriateness of the cardiac computed tomography angiography (CCTA) prescriptions according to the "2010-Appropriate-Use-Criteria-for-Cardiac-Computed-Tomography-Angiography" (AUCCTA) and "Clinical-indication-for-CCTA" (CICCTA) among different specialities (Cardiologist [CA], General Practitioner [GP], Other Specialists [OS]) and prescribers' age. MATERIALS AND METHODS This is a single-centre, single-arm, cohort study. We prospectively enrolled 815 patients (October 2012-May 2019) who underwent a radiological outpatient visit, before CCTA examination. Prescriptions to the examination were categorized as follows: Appropriate (A), Uncertain (U) and Inappropriate (Ina), according to AUCCTA and I, II, III and Inv for CICCTA. This categorization was stratified according to CA, GP and OS and prescribers' age. CCTA was performed in patients whom indications belong to A/U categories. RESULTS Eight hundred and fifteen CCTA prescriptions were analysed. An yearly increase in prescriptions was found in the eight-year observational period (2012/2019 projection: 72 vs 223). Considering AUCCTA, indication A was 540/815 (66.3%), indication U was 113/815 (13.9%) and Ina accounted for 162/815 (19.9%; 128/162 [79.0%] indications with stress test listed as criterium of inappropriateness). Only U indications decreased over years (p = 0.003). Regarding CICCTA, 501/815 (61.5%) patients were categorized as I, 144/815 (17.7%) as II, 102/815 (12.5%) as III, 67/815 (8.2%) were INV and 1/815 (0.1%) were non-classified. Clinical referrals were CA in 495/786 (63.0%), GPs in 57/786 (7.3%) GP and OS in 234/786 (29.8%) [p < 0.01]. No statistically significant differences were observed in the appropriateness among different specialty physicians. Younger doctors have a lower chance to not meet A indication (OR 0.98 [CI 95% 0.96-0.99]; p = 0.003). CONCLUSION Our study highlights the importance of a pre-radiological visit prior to CCTA, which prevented execution of 19.9% of inappropriate examinations. Age of prescribers had an impact on appropriateness, with younger doctors having a lower chance to not meet A indication.
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Ramzan A, Nazeer A, Irfan A, Al-Sehemi AG, Verpoort F, Khatak ZA, Ahmad A, Munawar MA, Khan MA, Basra MAR. Synthesis and Antiplatelet Potential Evaluation of 1,3,4-Oxadiazoles Derivatives. Z PHYS CHEM 2019. [DOI: 10.1515/zpch-2018-1316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abstract
A novel series of 2-(3-methyl-1,6-diphenyl-1H-pyrazolo[3,4-b]pyridin-4-yl)-5-aryl-1,3,4-oxadiazoles (4a–4h) has been synthesized from corresponding hydrazones (3a–3h) and evaluated their antiplatelet aggregation effect induced by arachidonic acid and collagen. Spectral data and elemental evaluation were used to confirm the structure of the compounds while molecular docking against cyclooxygenase 1 and 2 (COX1 & COX2) and quantitative structure-activity relationship (QSAR) were performed in describing their antiplatelet potential. All synthesized compound exhibited more than 50% platelet aggregation inhibition against both arachidonic acid and collagen. Antiplatelet activities results showed that 4b and 4f compounds have highest % inhibition against arachidonic acid. High Egap and ionization potential values showed that the compound 4d, 4e and 4f were supposed to be more active and good electron donor while 4b, 4c, 4d, 4e, 4g and 4h might be more active due to more electrophilic sites. Interaction with more than one residues in the binding pocket of COX-1 in comparison with aspirin and ligand efficacy (LE) consequences showed that compounds have excellent action potential for COX-1. Computational evaluations are in good agreement with antiplatelet activities of the compounds. All compounds might be promising antiplatelet agents especially 4b, 4f and helpful in the synthesis of new drugs for the treatment of cardiovascular diseases (CVDs).
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Affiliation(s)
- Ayesha Ramzan
- Institute of Chemistry, University of the Punjab, Quaid-e-Azam (New) Campus , Lahore 54590 , Pakistan
| | - Areesha Nazeer
- Institute of Chemistry, University of the Punjab, Quaid-e-Azam (New) Campus , Lahore 54590 , Pakistan
| | - Ahmad Irfan
- Department of Chemistry, Faculty of Science , King Khalid University , P.O. Box 9004, Abha 61413 , Saudi Arabia
| | - Abdullah G. Al-Sehemi
- Research Center for Advanced Materials Science (RCAMS), King Khalid University , P.O. Box 9004, Abha 61413 , Saudi Arabia
| | - Francis Verpoort
- Laboratory of Organometallics , Catalysis and Ordered Materials, State Key Laboratory of Advanced Technology for Material Synthesis and Processing, Wuhan University of Technology , Wuhan 430070 , China
| | - Zafar A. Khatak
- Laboratory of Organometallics , Catalysis and Ordered Materials, State Key Laboratory of Advanced Technology for Material Synthesis and Processing, Wuhan University of Technology , Wuhan 430070 , China
| | - Aftab Ahmad
- Center of Excellence in Molecular Biology, University of the Punjab , Lahore , Pakistan
| | - Munawar A. Munawar
- Institute of Chemistry, University of the Punjab, Quaid-e-Azam (New) Campus , Lahore 54590 , Pakistan
| | - Misbahul A. Khan
- Institute of Chemistry, University of the Punjab, Quaid-e-Azam (New) Campus , Lahore 54590 , Pakistan
- Department of Chemistry , The Islamia University of Bahawalpur , Bahawalpur 63100 , Pakistan , Tel./Fax: +96-42-99230463 Ext. 839
| | - Muhammad Asim Raza Basra
- Institute of Chemistry, University of the Punjab, Quaid-e-Azam (New) Campus , Lahore 54590 , Pakistan , e-mail:
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Hirai K, Imamura S, Hirai A, Misumi K, Ookawara S, Morishita Y. Risk factors and utility of maximum carotid intima-media thickness as a surrogate marker for coronary artery stenosis. Ther Clin Risk Manag 2018; 14:1407-1416. [PMID: 30147324 PMCID: PMC6095113 DOI: 10.2147/tcrm.s168926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study investigated the factors associated with coronary artery stenosis in outpatients. Furthermore, the usefulness of maximum carotid intima–media thickness (maximum-IMT) as a surrogate marker of coronary artery stenosis was evaluated. Methods We conducted a single-center retrospective study. A total of 601 outpatients (338 males; 263 females; mean age, 69.8±10.0 years) who underwent coronary computed tomography angiography between April 2006 and March 2012 were analyzed. The associations between coronary artery stenosis (≥75%) as determined by coronary computed tomography angiography and clinical and laboratory parameters were evaluated by multivariate logistic regression. Validation of maximum-IMT as measured by ultrasonography as a surrogate marker of coronary artery stenosis was analyzed by receiver operating characteristic (ROC) curve analysis. Results The estimated glomerular filtration rate (eGFR: mL/min/1.73 m2) (odds ratio [OR] 0.985, p<0.01), diabetes mellitus (OR 1.98, p<0.05), and maximum-IMT (mm) (OR 1.76, p<0.01) were significantly associated with coronary artery stenosis (≥75%). In analysis of each group categorized by identified factors, such as renal impairment (eGFR <60 mL/min/1.73 m2) and diabetes mellitus, the ROC curve of maximum-IMT was significant in the group of patients with diabetes mellitus without renal impairment (p<0.01) (cutoff value of maximum-IMT, 2.0 mm; sensitivity, 0.74; and specificity, 0.54) but not in other groups. Conclusion Renal impairment, diabetes mellitus, and increased maximum-IMT may be significant risk factors of coronary artery stenosis. Maximum-IMT as measured by ultrasonography may be a useful surrogate marker for coronary artery stenosis in patients with diabetes mellitus without renal impairment but not in other patients.
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Affiliation(s)
- Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Shigeki Imamura
- Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Aizan Hirai
- Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Kazuo Misumi
- Division of Cardiology, Heart Institute, Chiba-Nishi General Hospital, Chiba, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
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Kan H, van der Zant FM, Wondergem M, Knol RJJ. Incidental extra-cardiac findings on 13N-ammonia myocardial perfusion PET/CT. J Nucl Cardiol 2017; 24:1860-1868. [PMID: 28390039 DOI: 10.1007/s12350-017-0824-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of this study was to describe the prevalence of incidental extra-cardiac findings (IECFs) on myocardial perfusion PET/CTs and the prevalence of potentially clinically relevant and clinically irrelevant IECFs, as well as detection rate of previously unknown malignancies. METHODS AND RESULTS From September 2013 until February 2016, a total of 1397 consecutive patients referred for the evaluation of possible ischemia by 13NH3 PET/CT were prospectively included in a database. IECFs were categorized into three groups: potentially clinically relevant IECFs, IECFs that could potentially cause chest pain, and clinically irrelevant IECFs. Additionally, the prevalence of previously unknown malignancies was determined. In 717 (51%) of these patients, 775 IECFs were reported and 115 IECFs were categorized as potentially clinically relevant in 109 (8%) patients. A total of 145 IECFs that could potentially cause chest pain were detected in 139 (10%) patients and 515 clinically irrelevant IECFs were detected in 469 (34%) of the patients. An unknown primary malignancy was histologically proven in 19 patients (1.4%). CONCLUSIONS IECFs are detected on myocardial perfusion PET/CT in approximately half of the patients. In the present study, IECFs were potentially clinically relevant in 8% of the patients and in 1.4% an unknown malignancy was found, most of which were lung cancers.
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Affiliation(s)
- H Kan
- Cardiac Imaging Division Alkmaar, Northwest Clinics, Alkmaar, The Netherlands.
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - F M van der Zant
- Cardiac Imaging Division Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - M Wondergem
- Cardiac Imaging Division Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - R J J Knol
- Cardiac Imaging Division Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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Canceled coronary computed tomography angiography: Downstream testing and outcomes. Int J Cardiol 2017; 227:457-461. [DOI: 10.1016/j.ijcard.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/03/2016] [Indexed: 01/07/2023]
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Danad I, Szymonifka J, Schulman-Marcus J, Min JK. Static and dynamic assessment of myocardial perfusion by computed tomography. Eur Heart J Cardiovasc Imaging 2016; 17:836-44. [PMID: 27013250 DOI: 10.1093/ehjci/jew044] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/18/2016] [Indexed: 12/13/2022] Open
Abstract
Recent developments in computed tomography (CT) technology have fulfilled the prerequisites for the clinical application of myocardial CT perfusion (CTP) imaging. The evaluation of myocardial perfusion by CT can be achieved by static or dynamic scan acquisitions. Although both approaches have proved clinically feasible, substantial barriers need to be overcome before its routine clinical application. The current review provides an outline of the current status of CTP imaging and also focuses on disparities between static and dynamic CTPs for the evaluation of myocardial blood flow.
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Affiliation(s)
- Ibrahim Danad
- NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York 10021, NY, USA Dalio Institute of Cardiovascular Imaging, New York, NY, USA
| | - Jackie Szymonifka
- NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York 10021, NY, USA Dalio Institute of Cardiovascular Imaging, New York, NY, USA
| | | | - James K Min
- NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York 10021, NY, USA Dalio Institute of Cardiovascular Imaging, New York, NY, USA
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van der Zant FM, Wondergem M, Lazarenko SV, Geenen RW, Umans VA, Cornel JH, Knol RJ. Ruling Out Coronary Artery Disease in Women with Atypical Chest Pain: Results of Calcium Score Combined with Coronary Computed Tomography Angiography and Associated Radiation Exposure. J Womens Health (Larchmt) 2015; 24:550-6. [DOI: 10.1089/jwh.2014.4929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Maurits Wondergem
- Department of Cardiac Imaging, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Sergiy V. Lazarenko
- Department of Cardiac Imaging, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Remy W.F. Geenen
- Department of Cardiac Imaging, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Victor A. Umans
- Department of Cardiac Imaging, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Jan-Hein Cornel
- Department of Cardiac Imaging, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Remco J.J. Knol
- Department of Cardiac Imaging, Medical Center Alkmaar, Alkmaar, The Netherlands
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12
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Wong DTL, Soh SY, Ko BSH, Cameron JD, Crossett M, Nasis A, Troupis J, Meredith IT, Seneviratne SK. Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther 2014; 4:299-306. [PMID: 25276615 DOI: 10.3978/j.issn.2223-3652.2014.08.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study aims to compare the image quality of second generation versus first generation 320-computed tomography coronary angiography (CTCA) in patients with heart rate ≥65 bpm as it has not been specifically reported. METHODS Consecutive patients who underwent CTCA using second-generation-320-detector-row-CT were prospectively enrolled. A total of 50 patients with elevated (≥65 bpm) heart rate and 50 patients with controlled (<65 bpm) heart rate were included. Age and gender matched patients who were scanned with the first-generation-320-detector-row-CT were retrospectively identified. Image quality in each coronary artery segment was assessed by two blinded CT angiographers using the five-point Likert scale. RESULTS In the elevated heart rate cohorts, while there was no significant difference in heart rate during scan-acquisition (66 vs. 69 bpm, P=0.308), or body mass index (28.5 vs. 29.6, P=0.464), the second generation scanner was associated with better image quality (3.94±0.6 vs. 3.45±0.8, P=0.001), and with lower radiation (2.8 vs. 4.3 mSv, P=0.009). There was no difference in scan image quality for the controlled heart rate cohorts. CONCLUSIONS The second generation CT scanner provides better image quality at lower radiation dose in patients with elevated heart rate (≥65 bpm) compared to first generation CT scanner.
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Affiliation(s)
- Dennis T L Wong
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Siang Y Soh
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Brian S H Ko
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - James D Cameron
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Marcus Crossett
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Arthur Nasis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - John Troupis
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Ian T Meredith
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- 1 Monash Heart, Monash Cardiovascular Research Centre & Monash University, Clayton, Victoria, Australia ; 2 Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
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Zeb I, Abbas N, Nasir K, Budoff MJ. Coronary computed tomography as a cost–effective test strategy for coronary artery disease assessment – A systematic review. Atherosclerosis 2014; 234:426-35. [DOI: 10.1016/j.atherosclerosis.2014.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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Ferreira AM, Marques H, Gonçalves PA, Cardim N. Cost-effectiveness of different diagnostic strategies in suspected stable coronary artery disease in Portugal. Arq Bras Cardiol 2014; 102:391-402. [PMID: 24844876 PMCID: PMC4023916 DOI: 10.5935/abc.20140042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 12/10/2013] [Indexed: 11/20/2022] Open
Abstract
Background Cost-effectiveness is an increasingly important factor in the choice of a
test or therapy. Objective To assess the cost-effectiveness of various methods routinely used for the
diagnosis of stable coronary disease in Portugal. Methods Seven diagnostic strategies were assessed. The cost-effectiveness of each
strategy was defined as the cost per correct diagnosis (inclusion or
exclusion of obstructive coronary artery disease) in a symptomatic patient.
The cost and effectiveness of each method were assessed using Bayesian
inference and decision-making tree analyses, with the pretest likelihood of
disease ranging from 10% to 90%. Results The cost-effectiveness of diagnostic strategies was strongly dependent on the
pretest likelihood of disease. In patients with a pretest likelihood of
disease of ≤50%, the diagnostic algorithms, which include cardiac computed
tomography angiography, were the most cost-effective. In these patients,
depending on the pretest likelihood of disease and the willingness to pay
for an additional correct diagnosis, computed tomography angiography may be
used as a frontline test or reserved for patients with positive/inconclusive
ergometric test results or a calcium score of >0. In patients with a
pretest likelihood of disease of ≥ 60%, up-front invasive coronary
angiography appears to be the most cost-effective strategy. Conclusions Diagnostic algorithms that include cardiac computed tomography angiography
are the most cost-effective in symptomatic patients with suspected stable
coronary artery disease and a pretest likelihood of disease of ≤50%. In
high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive
coronary angiography appears to be the most cost-effective strategy. In all
pretest likelihoods of disease, strategies based on ischemia appear to be
more expensive and less effective compared with those based on anatomical
tests.
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Faria Alves M, Ferreira AM, Cardoso G, Saraiva Lopes R, Correia MDG, Machado Gil V. [Pre- and post-test probability of obstructive coronary artery disease in two diagnostic strategies: relative contributions of exercise ECG and coronary CT angiography]. Rev Port Cardiol 2013; 32:211-8. [PMID: 23454068 DOI: 10.1016/j.repc.2012.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 06/04/2012] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The purpose of this study was to assess the change in theoretical probability of coronary artery disease (CAD) in patients with suspected CAD undergoing coronary CT angiography (CCTA) as first line test vs. patients who underwent CCTA after an exercise ECG. METHODS Pre- and post-test probabilities of CAD were assessed in 158 patients with suspected CAD undergoing dual-source CCTA as the first-line test (Group A) and in 134 in whom CCTA was performed after an exercise ECG (Group B). Pre-test probabilities were calculated based on age, gender and type of chest pain. Post-test probabilities were calculated according to Bayes' theorem. RESULTS There were no significant differences between the groups regarding pre-test probability (median 23.5% [13.3-37.8] in group A vs. 20.5% [13.4-34.5] in group B; p=0,479). In group A, the percentage of patients with intermediate likelihood of disease (10-90%) was 90% before testing and 15% after CCTA (p<0,001), while in group B, it was 95% before testing, 87% after exercise ECG (p=NS), and 17% after CCTA (p<0,001). CONCLUSION Unlike exercise testing, CCTA is able to reclassify the risk in the majority of patients with an intermediate probability of obstructive CAD. The use of CCTA as a first-line diagnostic test for CAD may be beneficial in this setting.
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Affiliation(s)
- Miguel Faria Alves
- Departamento Cardiovascular, Hospital dos Lusíadas, Grupo de Hospitais Privados de Portugal, Lisboa, Portugal.
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Faria Alves M, Ferreira AM, Cardoso G, Saraiva Lopes R, Correia MDG, Machado Gil V. Pre- and post-test probability of obstructive coronary artery disease in two diagnostic strategies: Relative contributions of exercise ECG and coronary CT angiography. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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IMPACT OF COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY ON OTHER DIAGNOSTIC TESTS. Int J Technol Assess Health Care 2012; 28:424-8. [DOI: 10.1017/s0266462312000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: Information on the impact of computed tomography coronary angiography (CTCA) on patterns of care is scarce. In particular, it is not clear if, and to what extent, its adoption actually leads to a reduction in the use of other diagnostics tools. The aim of this study was to evaluate whether the adoption of CTCA in Emilia-Romagna (an Italian region with a population of 4.4 million) had any effect on utilization rates of myocardial perfusion scintigraphy (MPS) and coronary angiography (CA).Methods: Interrupted time series (ITS) were applied to monthly volumes of MPS and CA tests performed from 2003 to 2010, to assess trends in usage rates for those procedures before and after CTCA was adopted by all the healthcare organizations operating in the region.Results: After an increase in the first year of CTCA introduction, its use remained stable over the study period. After September 2006, a significant decrease in MPS volumes (31 percent; p < .0001) and a much less tangible decrease in CA volumes (5 percent; p < .0001), were detected by ITS analyses.Conclusions: This study demonstrates that the use of CTCA had a greater impact on MPS usage rates than on CA.
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Mudrick D, Kaltenbach LA, Shah B, Lytle B, Masoudi FA, Mark DB, Federspiel JJ, Cowper PA, Green C, Douglas PS. Downstream testing and subsequent procedures after coronary computed tomographic angiography following coronary stenting in patients ≥65 years of age. Am J Cardiol 2012; 110:776-83. [PMID: 22651883 DOI: 10.1016/j.amjcard.2012.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 11/12/2022]
Abstract
Limited data are available on the use of coronary computed tomographic angiography (CCTA) in patients who have received percutaneous coronary intervention (PCI). To evaluate patterns of cardiac testing including CCTA after PCI, we created a retrospective observational dataset linking National Cardiovascular Data Registry CathPCI Registry baseline data with longitudinal inpatient and outpatient Medicare claims data for patients who received coronary stenting from November 1, 2005 through December 31, 2007. In 192,009 patients with PCI (median age 74 years), the first test after coronary stenting was CCTA for 553 (0.3%), stress testing for 89,900 (46.8%), and coronary angiography for 22,308 (11.6%); 79,248 (41.3%) had no further testing. Patients referred to CCTA first generally had similar or lower baseline risk than those referred for stress testing or catheterization first. Compared to patients with stress testing first after PCI, patients who underwent CCTA first had higher unadjusted rates of subsequent noninvasive testing (10% vs 3%), catheterization (26% vs 15%), and revascularization (13% vs 8%) within 90 days of initial testing after PCI (p <0.0001 for all comparisons). In conclusion, despite similar or lesser-risk profiles, patients initially evaluated with CCTA after PCI had more downstream testing and revascularization than patients initially evaluated with stress testing. It is unclear whether these differences derive from patient selection, performance of CCTA compared to other testing strategies, or the association of early adoption of CCTA with distinct patterns of care.
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Ollendorf DA, Blackmore CC, Lee JM. Toward evidence-based decisions in diagnostic radiology: a research and rating process for multiple decision-makers. Acad Radiol 2012; 19:1049-54. [PMID: 22727624 DOI: 10.1016/j.acra.2012.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/02/2012] [Accepted: 04/03/2012] [Indexed: 11/29/2022]
Abstract
The use of diagnostic imaging tests and the development of evidence-based guidelines, reviews, and other materials have both undergone substantial growth in recent years. However, the proliferation of evidence-based information has not translated into the universal deployment of medical and coverage policy for diagnostic imaging that is similarly evidence-based. One possible reason is the failure of those institutions generating evidence-based information to format findings in an accessible manner for all relevant stakeholders. The Institute for Clinical and Economic Review has developed a simple and transparent method for rating evidence that is accessible to clinicians, patients, payers, and other policy makers. The authors describe this process in relation to three imaging-based examples (computed tomographic colonography, coronary computed tomographic angiography, and positron emission tomography for dementia neuropathology). The issues raised, controversies considered, and use of the ratings in setting policy are discussed in relation to each example.
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Affiliation(s)
- Daniel A Ollendorf
- Institute for Clinical and Economic Review, Massachusetts General Hospital, Boston, 02114, USA.
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Wallis A, Manghat N, Hamilton M. The role of coronary CT in the assessment and diagnosis of patients with chest pain. Clin Med (Lond) 2012; 12:222-9. [PMID: 22783772 PMCID: PMC4953483 DOI: 10.7861/clinmedicine.12-3-222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The role of cardiac computed tomography (CT) in the assessment and management of patients with suspected cardiac chest pain has been formally recognised in NICE guidance 95. When the technique and patient selection are appropriate, cardiac CT is a valuable diagnostic tool, particularly for patients with a low to intermediate pre-test probability of coronary artery disease. The physician must be aware of the implications of the recent guidelines; hence, we present an illustrated synopsis on the current technique and the indications for the use of calcium scoring and cardiac CT in the assessment and management of patients with suspected cardiac chest pain.
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Scott I. Reply. Intern Med J 2012. [DOI: 10.1111/j.1445-5994.2011.02651.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scott IA. Using computed tomography coronary angiography to evaluate patients with acute chest pain: putting the horse before the cart. Intern Med J 2011; 41:647-50. [DOI: 10.1111/j.1445-5994.2011.02554.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A Simulation Model of Clinical and Economic Outcomes of Cardiac CT Triage of Patients With Acute Chest Pain in the Emergency Department. AJR Am J Roentgenol 2011; 196:853-61. [DOI: 10.2214/ajr.10.4962] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cheaper, better, or good enough: Evidentiary standards for coronary CTA. J Cardiovasc Comput Tomogr 2011; 5:110-2. [DOI: 10.1016/j.jcct.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
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Affiliation(s)
- Rita F Redberg
- School of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA USA
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