Dual source computed tomography coronary angiography in new onset cardiomyopathy

Abstract

Aim: To evaluate safety and utility of coronary computed tomography angiography (CCTA) compared to invasive coronary angiography (ICA) in new cardiomyopathy.

Methods: Eighteen patients (mean age 56.5 years, 10 males) who presented for evaluation of new onset heart failure with evidence of systolic dysfunction (ejection fraction < 40%) on echocardiography and recent ICA were prospectively enrolled. Patients with known coronary artery disease, atrial fibrillation, creatinine > 1.5 g/dL, and contraindication to intravenous contrast administration were excluded. CCTA was performed using a dual source 64-slice scanner. Mean heart rate was 75 beats per minute. Stenosis was graded for each coronary segment as: none, mild (< 50%), moderate (50%-70%), severe (> 70%), or non-evaluable. Ischemic cardiomyopathy (ICM) was diagnosed if severe stenosis was present in the left main, proximal left anterior descending artery, or two or more major arteries.

Results: Two patients were diagnosed with ICM by ICA. CCTA correctly identified 2 patients with ICM and 16 patients as non-ICM. CCTA successfully evaluated 240/246 coronary segments with an accuracy of 97.5%, sensitivity 70%, specificity 98.7%, positive predictive value of 70%, and negative predictive value of 98.7% for identifying severe stenosis on a per-segment level.

Conclusion: Dual source 64-slice multi-detector CCTA is a safe, accurate, and non-invasive technique for diagnosing ICM in patients presenting during the acute phase of newly diagnosed cardiomyopathy.

Keywords: Cardiac computed tomography; Cardiomyopathy; Coronary artery disease; Heart failure.

Figure 1

A 78-year-old man with dilated cardiomyopathy associated with severe coronary artery disease. Curved reformations of the coronary computed tomography angiography images (top) and corresponding X-ray coronary angiography images (bottom) are shown for the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). Focal areas of severe stenoses (short arrows) are noted in the LAD and RCA.

Figure 2

A 58-year-old woman with dilated cardiomyopathy with no significant coronary artery disease. Curved reformations of the coronary computed tomography angiography images (top) and corresponding X-ray coronary angiography images (bottom) are shown for the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA).