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The Role of Computed Tomography for Diagnosing Heart Disease FREE

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The summary below is from the full report titled “Diagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery Disease.” It is in the 18 May 2010 issue of Annals of Internal Medicine (volume 152, pages 630-639). The authors are A.C. Weustink, N.R. Mollet, L.A. Neefjes, W.B. Meijboom, T.W. Galema, C.A. van Mieghem, S. Kyrzopoulous, R.N. Eu, K. Nieman, F. Cademartiri, R.J. van Geuns, E. Boersma, G.P. Krestin, and P.J. de Feyter.

Ann Intern Med. 2010;152(10):I-24. doi:10.7326/0003-4819-152-10-201005180-00001
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What is the problem and what is known about it so far?

Blockages of blood vessels to the heart are the most common cause of chest pain and heart attacks. Doctors typically diagnose these blockages by using stress tests and angiography. With stress tests, people run on a treadmill or are given medicine to increase the stress on their heart. Doctors then take pictures of the heart's blood flow to see whether it is abnormal. With angiography, doctors put a catheter into the heart, squirt dye into its vessels, and take x-rays to see the blockages. Angiography is more accurate than stress testing but is invasive, expensive, and occasionally harmful. Recently, computed tomography (CT or “CAT”) scans have been developed that can take pictures of the blood vessels in the heart (CT coronary angiography or CTCA). These scans are noninvasive, less expensive, and less harmful than standard angiography, but not a lot is known about their accuracy or how they should be used in comparison to standard testing.

Why did the researchers do this particular study?

To measure the accuracy of CTCA and see how it might best be used in combination with stress testing and standard angiography to diagnose heart vessel blockages.

Who was studied?

517 patients with chest symptoms who were referred to a university medical center for testing.

How was the study done?

The researchers performed stress testing, CTCA, and angiography for every patient. They compared stress testing and CTCA to angiography to assess the accuracy of each test. They used this information about accuracy to calculate the chance of having blood vessel blockage on the basis of the test results and determine when the tests should be used.

What did the researchers find?

Computed tomography coronary angiography was almost as accurate as standard angiography. However, it seemed to be unnecessary in people who were unlikely to have blockages, because stress testing was sufficient; its results were often negative and suggested no need for more testing. The test also seemed unnecessary in patients with a high chance of having blockages, because the results were often positive and these patients needed standard angiography anyway. The most appropriate patients to receive CTCA seemed to be those with an intermediate chance of having blockages, because the test distinguished between those who did and those who did not need standard angiography.

What were the limitations of the study?

The findings apply to people already seen by their doctors for chest symptoms and referred for testing. Stress testing gives different information from either CTCA or angiography, and so it might still be appropriate in combination with those tests.

What are the implications of the study?

Computed tomography coronary angiography is accurate but probably best done in persons with an intermediate chance of having heart vessel blockages. Persons who are unlikely to have blockages can probably just have simpler stress testing, whereas those with a higher chance of having blockages should probably have standard angiography.





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