Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation: initial experience.

Abstract

To prospectively evaluate the sensitivity and specificity of dual-source CT for significant coronary stenosis (>50% narrowing) in patients with atrial fibrillation (AF), by using conventional coronary angiography as the reference standard. Institutional Review Board approval and informed consent were obtained. Fifteen consecutive patients (nine men, six women; mean age, 58.47 years) were examined. Image quality (good, moderate, or poor) and significant stenosis (>50%) were evaluated by two radiologists blinded to the conventional coronary angiography results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated. McNemar test was used to search for any significant difference between dual-source CT and conventional coronary angiography in helping detect coronary stenosis. kappa statistics were calculated for intermodality and interobserver agreement. Sixteen segments by reader 1 and 13 segments by reader 2 were considered as poor image quality and rejected for further analysis. All segments with good image quality were correctly diagnosed. The respective overall sensitivity, specificity, PPV, and NPV values were 87%, 98%, 77%, and 99% for reader 1 and 80%, 99%, 80%, and 99% for reader 2. No significant difference between dual-source CT and conventional coronary angiography was found in helping detect significant stenosis. kappa statistics demonstrated good intermodality and excellent interobserver agreement. Dual-source CT technology provides a temporal resolution that allows CT coronary angiography at higher heart rates and even with AF.