Is multidetector computed tomography safe and accurate for evaluating coronary disease in patients with dilated cardiomyopathy?
For patients with dilated cardiomyopathy (DCM) of unclear etiology who require coronary evaluation, multidetector computed tomography (MDCT) provides a highly accurate noninvasive method to identify coronary stenosis without the complications associated with angiography. (LOE = 1b)
Andreini D, Pontone G, Pepi M, et al. Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy. J Am Coll Cardiol 2007;49:2044-2050. [PMID:17512361]
Diagnostic test evaluation
Inpatient (any location)
These investigators enrolled 61 consecutive patients with DCM of unknown etiology and 139 patients referred for angiography for various indications. Included patients had no prior cardiac angiography, and no known coronary disease, renal impairment, or arrhythmias. All patients underwent MDCT followed by angiography within 3.1 days. The DCM patients had a mean age of 62 years; 23% were women. The mean ejection fraction was 34%, compared with 59% in the referral group. Based on angiography, 28% of DCM patients and 70% of referral patients had significant coronary stenosis (> 50%) of at least one vessel. Coronary artery visualization on MDCT was successful for 97% of segments. For patients with DCM, sensitivity, specificity, positive predictive value and negative predictive value of MDCT for coronary stenosis were 99%, 96%, 81%, and 99%, with positive and negative likelihood ratios of 25 and 0.01. These properties compared favorably with test characteristics in the referral group. The mean time needed for MDCT was 9 hours (versus 35 hours for angiography). There were no complications from MDCT in the DCM group, but 16% of these patients had complications resulting from angiography (acute heart failure: 10%; minor vascular complications: 6.5%). This was a small study conducted in a single center, and as patients with DCM and known coronary disease were excluded, the patients in this group had a low pretest probability of coronary artery disease.
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