Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain from the ROMICAT trial

Sujith K. Seneviratne, Quynh A. Truong, Fabian Bamberg, Ian S. Rogers, Michael D. Shapiro, Christopher L. Schlett, Claudia U. Chae, Ricardo Cury, Suhny Abbara, Thomas J. Brady, John T. Nagurney, Udo Hoffmann

Research output: Contribution to journalArticle

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Abstract

Background-The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain. Methods and Results-We analyzed 356 patients (mean age, 53±12 years; 62% men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50%) were separately assessed by 2 independent readers. Incre mental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive coronary artery disease, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74% (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10% increase in sensitivity to detect ACS by cardiac computed tomography (87%; 95% confidence interval, 70% to 96%) and significantly improved the overall accuracy (c-statistic: 0.88 versus 0.94 and 0.79 versus 0.88, for extent of plaque and presence of stenosis, respectively; both P<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89% sensitivity and 86% specificity in patients with significant stenosis (n=33) and 60% sensitivity and 86% specificity in patients with inconclusive coronary computed tomographic angiography (n=33). Conclusions-Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS.

Original languageEnglish (US)
Pages (from-to)375-383
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume3
Issue number4
DOIs
StatePublished - Jul 2010

Fingerprint

Acute Pain
Acute Coronary Syndrome
Chest Pain
Left Ventricular Function
Tomography
Pathologic Constriction
Coronary Artery Disease
Sensitivity and Specificity
Unstable Angina
Atherosclerotic Plaques
Caregivers
Hospital Emergency Service
Angiography
Hospitalization
Myocardial Infarction
Confidence Intervals
Calcium

Keywords

  • Acute coronary syndrome
  • Computed tomography
  • Emergency Department
  • Left ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain from the ROMICAT trial. / Seneviratne, Sujith K.; Truong, Quynh A.; Bamberg, Fabian; Rogers, Ian S.; Shapiro, Michael D.; Schlett, Christopher L.; Chae, Claudia U.; Cury, Ricardo; Abbara, Suhny; Brady, Thomas J.; Nagurney, John T.; Hoffmann, Udo.

In: Circulation: Cardiovascular Imaging, Vol. 3, No. 4, 07.2010, p. 375-383.

Research output: Contribution to journalArticle

Seneviratne, Sujith K. ; Truong, Quynh A. ; Bamberg, Fabian ; Rogers, Ian S. ; Shapiro, Michael D. ; Schlett, Christopher L. ; Chae, Claudia U. ; Cury, Ricardo ; Abbara, Suhny ; Brady, Thomas J. ; Nagurney, John T. ; Hoffmann, Udo. / Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain from the ROMICAT trial. In: Circulation: Cardiovascular Imaging. 2010 ; Vol. 3, No. 4. pp. 375-383.
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abstract = "Background-The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain. Methods and Results-We analyzed 356 patients (mean age, 53±12 years; 62{\%} men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50{\%}) were separately assessed by 2 independent readers. Incre mental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive coronary artery disease, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74{\%} (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10{\%} increase in sensitivity to detect ACS by cardiac computed tomography (87{\%}; 95{\%} confidence interval, 70{\%} to 96{\%}) and significantly improved the overall accuracy (c-statistic: 0.88 versus 0.94 and 0.79 versus 0.88, for extent of plaque and presence of stenosis, respectively; both P<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89{\%} sensitivity and 86{\%} specificity in patients with significant stenosis (n=33) and 60{\%} sensitivity and 86{\%} specificity in patients with inconclusive coronary computed tomographic angiography (n=33). Conclusions-Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS.",
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T1 - Incremental diagnostic value of regional left ventricular function over coronary assessment by cardiac computed tomography for the detection of acute coronary syndrome in patients with acute chest pain from the ROMICAT trial

AU - Seneviratne, Sujith K.

AU - Truong, Quynh A.

AU - Bamberg, Fabian

AU - Rogers, Ian S.

AU - Shapiro, Michael D.

AU - Schlett, Christopher L.

AU - Chae, Claudia U.

AU - Cury, Ricardo

AU - Abbara, Suhny

AU - Brady, Thomas J.

AU - Nagurney, John T.

AU - Hoffmann, Udo

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N2 - Background-The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain. Methods and Results-We analyzed 356 patients (mean age, 53±12 years; 62% men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50%) were separately assessed by 2 independent readers. Incre mental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive coronary artery disease, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74% (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10% increase in sensitivity to detect ACS by cardiac computed tomography (87%; 95% confidence interval, 70% to 96%) and significantly improved the overall accuracy (c-statistic: 0.88 versus 0.94 and 0.79 versus 0.88, for extent of plaque and presence of stenosis, respectively; both P<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89% sensitivity and 86% specificity in patients with significant stenosis (n=33) and 60% sensitivity and 86% specificity in patients with inconclusive coronary computed tomographic angiography (n=33). Conclusions-Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS.

AB - Background-The incremental value of regional left ventricular function (LVF) over coronary assessment to detect acute coronary syndrome (ACS) is uncertain. Methods and Results-We analyzed 356 patients (mean age, 53±12 years; 62% men) with acute chest pain and inconclusive initial emergency department evaluation. Patients underwent 64-slice contrast-enhanced cardiac computed tomography before hospital admission. Caregivers and patients remained blinded to the results. Regional LVF and presence of coronary atherosclerotic plaque and significant stenosis (>50%) were separately assessed by 2 independent readers. Incre mental value of regional LVF to predict ACS was determined in the entire cohort and in subgroups of patients with nonobstructive coronary artery disease, inconclusive assessment for stenosis (defined as inability to exclude significant stenosis due to calcium or motion), and significant stenosis. During their index hospitalization, 31 patients were ultimately diagnosed with ACS (8 myocardial infarction, 22 unstable angina), of which 74% (23 patients) had regional LV dysfunction. Adding regional LVF resulted in a 10% increase in sensitivity to detect ACS by cardiac computed tomography (87%; 95% confidence interval, 70% to 96%) and significantly improved the overall accuracy (c-statistic: 0.88 versus 0.94 and 0.79 versus 0.88, for extent of plaque and presence of stenosis, respectively; both P<0.03). The diagnostic accuracy of regional LVF for detection of ACS has 89% sensitivity and 86% specificity in patients with significant stenosis (n=33) and 60% sensitivity and 86% specificity in patients with inconclusive coronary computed tomographic angiography (n=33). Conclusions-Regional LVF assessment at rest improves diagnostic accuracy for ACS in patients with acute chest pain, especially in those with coronary artery disease and thus may be helpful to guide further management in patients at intermediate risk for ACS.

KW - Acute coronary syndrome

KW - Computed tomography

KW - Emergency Department

KW - Left ventricular function

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