64-slice peripheral computed tomography angiography: a clinical accuracy evaluation.
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Jeffrey J Fine
Publications and source records attributed to Jeffrey J Fine.
Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease.
Cardiovascular computed tomography (CVCT) with the recently released 64-slice technology increases spatial resolution and decreases acquisition times and slice thickness. We investigated the accuracy of 64-slice CVCT in relation to catheter angiography. We studied 66 sequential subjects who underwent 64-slice CVCT and catheter angiography within 30 days. Accuracy results were 94% for interpretable images, 95% for sensitivity, 96% for specificity, 97% for positive predictive value, and 92% for negative predictive value for lesions with >50% stenosis. We found 100% agreement between 64-slice CVCT and catheterization among vein graft evaluations (9 of 9). These metrics are vastly improved from the 16-slice generation and support 64-slice CVCT as a reliable diagnostic tool.
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Abnormal ankle brachial indices may predict cardiovascular disease among diabetic patients without known heart disease.
BACKGROUND: Cardiovascular disease remains the primary cause of diabetes-associated morbidity and mortality. Previous studies have failed to provide accurate, inexpensive, screening techniques to detect cardiovascular disease in diabetics. Ankle brachial indices (ABI) testing may be an effective screening technique for diabetics. METHODS AND RESULTS: The aim of this 100-subject clinical study was to determine cardiovascular disease prevalence, via perfusion stress testing, in diabetic patients having abnormal ABI (<0.90) and without known heart disease who were referred to the South Carolina Heart Center, Columbia, SC for nuclear perfusion stress testing. Study data were analyzed using frequency and descriptive statistics and 2-sample T-testing. Mean subject age was 62+/-11 years, ABI 0.76+/-13, and ejection fraction 60+/-12%. Perfusion stress testing detected 49 abnormal electrocardiograms, 36 subjects with coronary ischemia, 20 with diminished left ventricular function, and 26 subjects having significant thinning of the myocardium. There were 71 subjects who tested positive for at least one form of cardiovascular disease. The sole predictive variable reaching significance for the presence of cardiovascular disease was an ABI score <0.90 (p< or =0.0001). CONCLUSION: Cardiovascular disease may be predicted among diabetic patients via ABI scores and confirmed by nuclear perfusion testing.
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Noninvasive coronary angiography: agreement of multi-slice spiral computed tomography and selective catheter angiography.
BACKGROUND: Technology advances in multislice detector computed tomography (MSCT) cardiac scanning, specifically in the application of intravenous injected contrast coronary angiography with EKG gating have led to the availability of this procedure in every day outpatient cardiac medicine. OBJECTIVE: The aim of this study is to test the head to head direct coronary angiography with MSCT coronary angiography in clinical situations where cardiac cath is traditionally utilized for management decisions. METHODS: We limited our analysis to vessels felt to be 1.5 mm or greater in diameter, recognizing diagnostic accuracy and medical importance of smaller vessels is low. All 50 patients (52% men, 48% women age range 34-78) were studied because of the clinical suspicion of obstructive coronary atherosclerosis. Blinded experts in direct and in MSCT independently read the studies and resolved disparities by a subsequent discussion. Standard protocols for direct and for MSCT angiography were used including use of IV and oral beta blockade to keep the heart rate at or below 60 beats per minute. RESULTS: 392 vessels were evaluated. MSCT provided images of sufficient technical quality to permit diagnosis in 98% (49/50) of cases. MSCT was 96% accurate in identifying patients as having either no disease, single vessel disease, or multiple vessel disease. For all vessels, MSCT identification of stenotic lesions of >50% were as follows: sensitivity 87%, specificity 97%, positive predictive value 80%, and negative predictive value 98%. Pearson correlation results between direct catheter and MSCT for absolute stenotic percentages were left main (0.92 p < 0.0001), left anterior descending (0.94 p < 0.0001), circumflex (0.94 p < 0.0001), first obtuse marginal (0.85 p < 0.0001), and right coronary artery (0.89 p < 0.0001). CONCLUSION: The accuracy of MSCT angiography compared favorably with that of direct cardiac cath in this cohort of patients. The high specificity of these findings suggest that one particular use of this technique will be to eliminate many unnecessary cardiac catheterization procedures by excluding obstructive, and therefore potentially PCI requiring, coronary artery disease. The medical cost savings of such an application may be very significant and bears further study.
Adrenergic beta-Antagonists↗
Predictive power of cardiovascular risk factors for detecting peripheral vascular disease.
OBJECTIVES: Peripheral vascular disease (PVD) is underdiagnosed in primary care due to the absence of established criteria to warrant diagnostic testing. Our goal was to establish a risk factor hierarchy to enable earlier diagnosis of PVD. METHODS: Data sets of 142 patients with abnormal ankle brachial indices (ABI) were randomly selected from our patient database to determine the prevalence of specific cardiovascular risk factors and demographic data. An ABI score < 0.90 is diagnostic of PVD. Patients were stratified into mild (0.75-0.89), moderate (0.50-0.74), and severe disease (< 0.50). RESULTS: Mean age was 69 +/- 9.9, ABI 0.65 +/- 0.16. Risk factor prevalence: diabetes, 42%; hypertension, 87%; tobacco use, 34%; hyperlipidemia, 53%; obesity, 24%; cardiovascular disease (CVD), 69%; stroke, 15%. Total risk factors per patient v = 3.2 +/- 1.3. Disease severity stratifications: mild, n = 46 (age v = 68.6 +/- 10.4, ABI v = 0.82 +/- 0.05); moderate, n = 72 (age v = 69.9 +/- 9.4, ABI v = 0.62 +/- 0.07); severe, n = 24 (age v = 67.5 +/- 10.9, ABI v = 0.40 +/- 0.06). Independent variable mean differences: hypertension-CVD (P = 0.0002); CVD-hyperlipidemia (P = 0.002); hyperlipidemia-diabetes (P = 0.0008); diabetes-tobacco use (P = 0.001); tobacco use-obesity (P = 0.0003); obesity-stroke (P = 0.05). Independent variable mean differences were significant across disease severity (P < 0.00001). CONCLUSIONS: Our study establishes the following hierarchy of cardiovascular risk factors as predictors of PVD: hypertension, cardiovascular disease, hyperlipidemia, diabetes, tobacco use, obesity, stroke.
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