Adding regional left ventricular function assessment to cardiac CT significantly improved the overall diagnostic accuracy for acute coronary syndrome (c-statistic 0.88 vs 0.79 for stenosis; P<0.03).
Observational (n=356)
Double-blind
Does adding regional left ventricular function assessment to coronary computed tomography improve the diagnostic accuracy for acute coronary syndrome in patients with acute chest pain?
Adding regional left ventricular function assessment to coronary CT angiography significantly improves diagnostic accuracy for acute coronary syndrome in patients with acute chest pain.
Effect estimate: c-statistic
Absolute Event Rate: 0.88% vs 0.79%
p-value: p=<0.03
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. Incremental 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.
Seneviratne et al. (Thu,) conducted a observational in Acute chest pain with inconclusive initial emergency department evaluation (n=356). Regional left ventricular function (LVF) assessment added to cardiac computed tomography vs. Coronary assessment by cardiac computed tomography alone was evaluated on Overall diagnostic accuracy (c-statistic) for detection of acute coronary syndrome (c-statistic, p=<0.03). Adding regional left ventricular function assessment to cardiac CT significantly improved the overall diagnostic accuracy for acute coronary syndrome (c-statistic 0.88 vs 0.79 for stenosis; P<0.03).
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