Carlo Tedeschi

Incremental value and safety of oral ivabradine for heart rate reduction in computed tomography coronary angiography

BACKGROUND Heart rate (HR) reduction is essential to achieve optimal image quality and diagnostic accuracy with computed tomography coronary angiography (CTCA). Administration of ivabradine could be an attractive alternative to beta-blockade to reduce HR. METHODS One-hundred-twenty-three patients referred for CTCA were prospectively enrolled. Patients were divided in two groups depending on the absence or presence of chronic beta-blockade treatment. Within the two groups patients were randomized to either no additional premedication or oral ivabradine for 5 days prior to CTCA. In presence of chronic beta-blockade therapy it was shifted to atenolol 50mg twice a day for 5 days prior to CTCA. HR and blood pressure were assessed at admission (T0), immediately before CTCA (T1) and during CTCA (T2). The target HR was <65 bpm. RESULTS Ivabradine significantly reduced HR during CTCA. Mean relative HR reduction was 15% for controls, 12% for chronic beta-blockade, 19% for ivabradine and 24% for both chronic beta-blockade and ivabradine at T2 (p for trend <0.001). The rate of patients who reached the target HR at T2 was 83% in controls, 71% with chronic beta-blockade, 97% with ivabradine and 97% with both (p for trend <0.05). The percentage of patients that needed additional IV beta-blockade at T1 decreased from 69% to 40% with ivabradine and 30% with both (p for trend <0.05). CONCLUSIONS Ivabradine is safe and effective in increasing the rate of patients at target HR and in reducing the need for additional IV beta-blockade in patients referred for CTCA.

Low dose CT of the heart: a quantum leap into a new era of cardiovascular imaging

In 10 years, computed tomography coronary angiography (CTCA) has shifted from an investigational tool to clinical reality. Even though CT technologies are very advanced and widely available, a large body of evidence supporting the clinical role of CTCA is missing. The reason is that the speed of technological development has outpaced the ability of the scientific community to demonstrate the clinical utility of the technique. In addition, with each new CT generation, there is a further broadening of actual and potential applications. In this review we examine the state of the art on CTCA. In particular, we focus on issues concerning technological development, radiation dose, implementation, training and organisation.RiassuntoL’angiografia coronarica con tomografia computerizzata (CTCA) è passata in 10 anni da strumento di ricerca investigativa a strumento clinico di uso routinario. Anche se le tecnologie sono molto diffuse ed avanzate, la maggioranza delle evidenze non supportano ancora in modo forte l’utilizzo di questa metodica. La causa di questo risiede probabilmente nel fatto che la velocità dell’evoluzione tecnologica ha superato ampiamente la capacità del mondo scientifico di sviluppare dati che definiscano meglio il campo di utilizzo. A questo si aggiunge il fatto che ad ogni nuova generazione di apparecchi per la tomografia computerizzata (TC) le reali e potenziali applicazioni si espandono ulteriormente. Abbiamo revisionato lo stato dell’arte corrente sulla CTCA. In particolare, vengono approfonditi gli aspetti inerenti l’evoluzione tecnologica, la dose da radiazioni ionizzanti, l’implementazione, il training e l’organizzazione.

Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data and review of multicentre trials.

PurposeThis study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CT-CA) for the detection of significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CCA) in a registry and to review major multicentre trials.Materials and methodsA total of 1,372 patients (882 men, 490 women; mean age 59.3±11.9 years) in sinus rhythm were studied with CT-CA (64-slice technology) and CCA. The diagnostic accuracy of CT-CA was evaluated against quantitative CCA as a reference standard for coronary artery stenosis. Positive and negative likelihood ratios and inter- and intraobserver agreement were calculated.ResultsThe prevalence of disease was 53%. CCA demonstrated the absence of significant coronary artery disease in 46.6% (639/1372), single-vessel disease in 24.7% (337/1372) and multivessel disease in 28.9% (396/1372) of patients. In per-patient analysis sensitivity, specificity and positive and negative predictive value of CT-CA were 99% [confidence interval (CI) 97–99], 92% (CI 89–94), 94% (CI 91–95) and 99% (CI 97–99), respectively. Per-patient and per-segment likelihood ratios (LR+=12.4 and LR−=0.011; LR+=18.3 and LR−=0.064, respectively), were good. Inter- and intraobserver variability was 0.78 and 0.85, respectively.ConclusionsCT-CA is a reliable diagnostic modality both in terms of sensitivity and negative predictive value. Differences in trial results are also due to the different parameters used for patient inclusion.RiassuntoObiettivoObiettivo di questo lavoro è stato valutare l’accuratezza diagnostica dell’angiografia coronarica non invasiva con tomografia computerizzata (CT-CA) a 64 strati nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥50%) confrontata con la coronarografia convenzionale (CAG) in un registro e revisionare i risultati dei trials multicentrici.Materiali e metodiSono stati studiati 1372 pazienti (882 uomini, 490 donne, età media 59,3±11,9 anni) in ritmo cardiaco sinusale con CT-CA (tecnologia 64 strati) e CAG. La CT-CA è stata eseguita secondo i protocolli comunemente utilizzati. L’accuratezza diagnostica è stata calcolata utilizzando la CAG come standard di riferimento. Sono state calcolate l’accuratezza diagnostica, i likelihood ratio positivo e negativo (LR+ e LR−) e la variabilità inter- ed intra-osservatore.RisultatiLa prevalenza di malattia nella popolazione era del 53%. Il 46,6% (639/1372) mostravano coronarie indenni o con lesioni che determinavano stenosi <50%, il 24,7% (337/1372) mostrano malattia critica di un solo vaso, ed il 28,9% (396/1372) dei pazienti mostrava coronaropatia critica multivasale. Nell’analisi per paziente la sensibilità, specificità, valore predittivo positivo e negativo della CT-CA sono risultati 99% (intervallo di confidenza [IC] 97–99), 92% (IC 89–94), 94% (IC 91–95), 99% (IC 97–99), rispettivamente. I likelihood ratio per paziente (LR+=12,4 e LR−=0,011) e per segmento (LR+=18,3 e LR−=0,064), sono risultati ottimali. Le variabilità inter- ed intra-osservatore sono risultate 0,78 e 0,85, rispettivamente.ConclusioniLa CT-CA è una metodica diagnostica affidabile sia per l’elevata sensibilità che per l’elevato valore predittivo negativo. I risultati dei trials sono variabili anche alla luce dei parametri principali di inclusione utilizzati.

CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease

Objective To evaluate diagnostic accuracy of exercise ECG (ex-ECG) versus 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in a population with low-to-intermediate pre-test likelihood of coronary artery disease (CAD). Design Retrospective single centre. Setting Tertiary academic hospital. Patients 177 consecutive patients (88 men, 89 women, mean age 53.5±7.6 years) with chest pain and low-to-intermediate pre-test likelihood of CAD were retrospectively enrolled. Interventions All patients underwent ex-ECG, CT-CA and invasive coronary angiography (ICA). Main outcome measure A lumen diameter reduction of ≥50% was considered as significant stenosis for CT-CA. Ex-ECG was classified as positive, negative or non-diagnostic. Results were compared with ICA. Diagnostic accuracy of CT-CA and ex-ECG was calculated using ICA as the reference standard. A parallel comparative analysis using a cut-off value of 70% for significant lumen reduction was also performed too. Results ICA disclosed an absence of significant stenosis (≥50% luminal narrowing) in 85.3% (151/177) patients, single-vessel disease in 9.0% (16/177) patients and multivessel disease in 5.6% (10/177) patients. Prevalence of obstructive disease at ICA was 14.7% (26/177). Sensitivity, specificity, positive and negative predictive values at the patient level were 100.0%, 98.7%, 92.9%, 100%, respectively, for CT-CA and 46.2%, 16.6%, 8.7%, 64.1%, respectively, for ex-ECG. Agreement between CT-CA and ex-ECG was 20.9%. CT-CA performed equally well in men and women, while ex-ECG had a better performance in men. After considering the cut-off value of 70% for significant stenosis, the difference between CT-CA and ex-ECG remained significant (p<0.01), with a low agreement (21.5%). Conclusions CT-CA provides optimal diagnostic performance in patients with atypical chest pain and low-to-intermediate risk of CAD. Ex-ECG has poor diagnostic accuracy in this population. Concerns are related to risk of radiation dose versus the benefits of correct disease stratification.

Prevalence of Coronary Artery Intramyocardial Course in a Large Population of Clinical Patients Detected by Multislice Computed Tomography Coronary Angiography

Background: Intramyocardial course, an inborn coronary anomaly, is defined as a segment of a major epicardial coronary artery that runs intramurally through the myocardium; in particular, we distinguish myocardial bridging, in which the vessel returns to an epicardial position after the muscle bridge, and intramyocardial course, which is described as a vessel running and ending in the myocardium. Purpose: To evaluate the prevalence of myocardial bridging and intramyocardial course of coronary arteries as defined by multidetector computed tomography (MDCT) angiography. Material and Methods: The study population consisted of 242 consecutive patients (211 men, 31 women; mean age 59±6 years) with atypical chest pain admitted to our hospital between December 2004 and September 2006. All MDCT examinations were performed using a 16-detector-row scanner (Aquilion 16 CFX; Toshiba Medical System, Tokyo, Japan). Patients with heart rate above 65 bpm received 50 mg atenolol orally for 3 days prior to the MDCT scan, or they increased their usual therapy with beta-blockers, in order to obtain a prescan heart rate <60 bpm. Curved multiplanar and 3D volume reconstructions were performed to explore coronary anatomy. Results: In 235 patients, the CT scan was successful and images were appropriate for evaluation. The prevalence of myocardial bridging and intramyocardial course of coronary arteries was 18.7% (47 cases) in our patient population. In 30 segments (63.8%), the vessels ran and ended in the myocardium. In the remaining 17 segments (36.2%), the vessels returned to an epicardial position after the muscle bridge. We found no difference in the prevalence of this inborn coronary anomaly when comparing different clinical characteristics of the study population (sex, age, body-mass index [BMI], etc.). The mean length of the subepicardial artery was 7 mm (range 5–12 mm), and the mean depth in the diastolic phase was 1.9 mm (range 1.2–2.3 mm). There was no significant difference of diameter in these segments between the different R–R phases examined. Conclusion: Our study is in agreement with major angiographic literature reporting a prevalence of myocardial bridging and intramyocardial course between 0.5% and 33%. MDCT technology represents a useful, noninvasive imaging method to assess and evaluate the location, depth, and length of this anatomical variation.

Prevalence of myocardial bridging and correlation with coronary atherosclerosis studied with 64-slice CT coronary angiography.

PurposeThis study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis.Materials and methodsA total of 277 patients (mean age 60±11 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments.ResultsMyocardial bridging was present in 82 patients (30%, mean age 59±12). Bridges were of variable length (<1 cm 58%; 1-2 cm 32%; >2 cm 10%) and depth (superficial 69%, intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), <50% stenosis (20%) or >50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p<0.0001).ConclusionsMSCT-CA is a reliable, noninvasive method that is able to depict myocardial bridging and associated atherosclerotic plaque in the proximal segments.RiassuntoObiettivoScopo del nostro lavoro è stimare la prevalenza e le caratteristiche dei ponti miocardici in una popolazione consecutiva di pazienti sottoposti ad angiografia coronarica mediante tomografia computerizzata multistrato (AC-TCMS), nonché valutare la relazione tra i decorsi miocardici e l’aterosclerosi coronarica.Materiali e metodiIn una popolazione di 277 pazienti (età media 60±11), sottoposti consecutivamente ad AC-TCMS con scanner a 64-strati per malattia aterosclerotica coronarica sospetta o nota, è stata ricercata la presenza di decorsi miocardici. Sono state valutate le placche aterosclerotiche presenti nei segmenti prossimali e distali al decorso miocardico, nonché nei restanti segmenti coronarici.RisultatiOttantadue pazienti (30%, età media 59±12) presentano decorso miocardico superficiale (69%) o intramiocardico (31%), con lunghezza variabile (<1 cm: 58%; 1–2 cm: 32%; >2 cm: 10%), frequentemente localizzato nel tratto medio-distale dell’arteria coronaria discendente anteriore (95%). Il ponte miocardico non rappresenta un fattore di rischio significativo di aterosclerosi coronarica (odds ratio 0,49) rispetto ai tradizionali fattori di rischio cardiovascolare. I segmenti prossimali mostrano: assenza di malattia (33%), rimodellamento positivo (27%), stenosi <50% (20%) o >50% (20%). Sono state visualizzate 12 placche non calcifiche, 32 miste e 17 calcifiche. Nei segmenti distali l’aterosclerosi non è rilevante (p<0,0001).ConclusioniLa AC-TCMS è una metodica non invasiva efficace nel dimostrare i ponti miocardici e le placche aterosclerotiche associate presenti nei segmenti prossimali.

Prevalence and characteristics of coronary artery disease in a population with suspected ischaemic heart disease using CT coronary angiography: correlations with cardiovascular risk factors and clinical presentation

Purpose . This study was undertaken to describe the correlation between the distribution of coronary artery disease (CAD) in a symptomatic population with suspected ischaemic heart disease, cardiovascular risk factors (RF) and clinical presentationMaterials and methods . We studied 163 patients (mean age 65.5 years; 101 men and 62 women) referred for multidetector computed tomography coronary angiography (MDCT-CA) to rule out CAD. The patients had no prior history of revascularisation or myocardial infarction. We analysed how the characteristics of CAD (severity and type of plaque) can change with the increase in RF and how they are related to different clinical presentationsResults . Patients were divided into three groups according to the number of RF: zero or one, two or three, and four or more. The percentage of coronary arteries with no plaque, nonsignificant disease and significant disease was 55%, 41% and 4%, respectively, in patients with zero or one RF; 27%, 51% and 22%, respectively, in patients with two or three RF; and 19%, 38% and 44%, respectively, in patients with four or more RF. Plaque in patients with nonsignificant disease was mixed in 65%, soft in 18% and calcified in 17%. The percentage of coronaries with no plaque in the three RF groups was 50%, 20% and 0% in patients with typical chest pain and 46%, 24% and 12% in those with atypical pain. The percentage of significant disease in patients with typical pain was 0%, 47% and 86% and in those with atypical pain 4%, 20% and 29%Conclusions . MDCT plays an important role in the identification of CAD in patients with suspected ischaemic heart disease. Severity and type of disease is highly correlated with RF number and assumes different characteristics according to clinical presentationRiassuntoObiettivo . Descrivere la correlazione esistente tra la distribuzione della patologia coronarica, in una popolazione sintomatica con sospetta cardiopatia ischemica, i fattori di rischio (FDR) cardiovascolari e la presentazione clinicaMateriali e metodi . Abbiamo studiato 163 pazienti (età media 65,5±10,6 anni; 101 maschi e 62 femmine) che hanno eseguito una angiografia coronarica mediante tomografia computerizzata multistrato (TCMS) con lo scopo di escludere la presenza di patologia coronarica; tutti i pazienti erano sintomatici e nessuno aveva storia di rivascolarizzazione o infarto miocardio. Abbiamo analizzato come le caratteristiche della malattia (severità e tipo di placca) possono cambiare con l’aumentare dei FDR e come sono correlate alle differenti presentazioni clinicheRisultati . Sono stati suddivisi i pazienti in tre gruppi in base al numero dei FDR: con 0 o 1, con 2 o 3 e con 4 o più FDR. La percentuale di coronarie indenni, malattia non significativa e malattia significativa era, rispettivamente, del 55%, 41%, 4% nei pazienti con 0 o 1 FDR, del 27%, 51%, 22% nei pazienti con 2 o 3 FDR e del 19%, 38%, 44% nei pazienti con 4 o più FDR. La placca nei pazienti con malattia non significativa era mista nel 65%, soft nel 18% e calcifica nel 17%. La percentuale di coronarie indenni nei tre gruppi di FDR era 50%, 20%, 0% nei pazienti con dolore tipico e 46%, 24%, 12% in quelli con dolore atipico, mentre la percentuale di malattia significativa nei pazienti con dolore tipico era 0%, 47%, 86% e in quelli con dolore atipico era 4%, 20%, 29%Conclusioni . La TCMS ha un ruolo importante nella identificazione della patologia coronarica nei pazienti con sospetta cardiopatia ischemica. La severità e il tipo di malattia è fortemente correlato al numero dei FDR e assume caratteristiche differenti in base alla presentazione clinica

Prognostic value of computed tomography coronary angiography in patients with chest pain of suspected cardiac origin

PurposeThe authors sought to determine the prognostic value of computed tomography coronary angiography (CTCA) in patients with acute chest pain (ACP).Materials and methodsA total of 145 consecutive patients (75 men; 64±12 years) with ACP were referred from the Emergency Department for CTCA, which was performed with a standard protocol using a 64-slice scanner. Patients were stratified according to the Morise clinical score (low, intermediate, high) and to the CTCA findings [absence of coronary artery disease (CAD), nonobstructive CAD, obstructive CAD]. Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation.ResultsOne hundred and twenty-seven (87.6%) patients were without a history of CAD, and 18 (12.4%) patients had a history of CAD. Obstructive CAD (>50% luminal narrowing) was detected in 35 (24%) patients; nonobstructive CAD (≤50% luminal narrowing) in 62 (43%) and absence of CAD in 48 (33%) patients. During a mean follow-up of 20±3 months, 20 events occurred (four hard events). Sixteen events (three hard events) occurred in patients without a history of CAD, and four events (one hard event) occurred in patients with a history of CAD. In patients with absence of CAD as detected by CTCA, the rate of events was 0%. At multivariate analysis, hypercholesterolaemia and obstructive CAD were significant predictors of events (p<0.05).ConclusionsAn excellent prognosis was observed in patients with ACP and normal CTCA. CTCA shows the potential for optimal stratification of patients with ACP.RiassuntoObiettivoScopo di questo lavoro è valutare il valore prognostico della angiografia coronarica mediante tomografia computerizzata (CTCA) in pazienti con dolore toracico acuto (ACP)Materiali e metodiCentoquarantacinque pazienti (75 maschi; 64±12 anni) consecutivi con ACP sono stati inviati a CTCA dal dipartimento di emergenza. La CTCA è stata effettuata con tecnica standard ed uno scanner a 64 strati. I pazienti sono stati stratificati secondo lo score di Morise (basso, intermedio, alto) e la CTCA (assenza di coronary artery disease [CAD], CAD non ostruttiva, CAD ostruttiva). I pazienti sono stati seguiti per l’occorrenza di eventi maggiori: morte cardiaca, infarto miocardico non fatale, angina instabile e rivascolarizzazioneRisultatiCentoventisette (87,6%) pazienti non avevano storia di CAD e 18 (12,4%) pazienti avevano storia di CAD. È stata rilevata CAD ostruttiva (riduzione del lume >50%) in 35 (24%) pazienti; CAD non ostruttiva (riduzione del lume ≤50%) in 62 (43%) pazienti e assenza di CAD in 48 (33%) pazienti. Durante un follow-up medio di 20±3 mesi, abbiamo riscontrato 20 eventi (4 eventi hard). Sedici eventi (3 eventi hard) si sono verificati in pazienti senza storia di CAD e 4 eventi (1 evento hard) si è verificato nei pazienti con storia di CAD. Nei pazienticon assenza di CAD secondo la CTCA la frequenza di eventi è stata pari allo 0%. All’analisi multivariata, l’ipercolesterolemia e la CAD ostruttiva sono risultati predittori significativi di eventi (p<0,05)ConclusioniNei pazienti con ACP la CTCA conferisce prognosi ottima alle coronarie esenti da CAD. La CTCA ha il potenziale per una ottimale stratificazione del rischio nei pazienti con ACP

Coronary artery calcium score on low-dose computed tomography for lung cancer screening

AIM To evaluate the feasibility of coronary artery calcium score (CACS) on low-dose non-gated chest CT (ngCCT). METHODS Sixty consecutive individuals (30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed tomography (gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner (Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores (Volume, Mass, Agatston) as previously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered significant. RESULTS Mean CACS values were significantly higher for gCCT as compared to ngCCT (Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high (Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2 (33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1 (33%) showed an Agatston score of 0 in the ngCCT. Overall, 23 (38%) patients were reclassified in a different cardiovascular risk category, mostly (18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT (DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01). CONCLUSION CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.

Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data on the impact of calcium score

PurposeThis study evaluated the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) at different coronary calcium score (CACS) values with conventional coronary angiography (CAG) as the reference standard.Material and methodsA total of 1,500 patients (928 men, mean age 58.2±12.5 years) in sinus rhythm who underwent CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR) of CTCA were evaluated against CAG for the total population and in different CACS classes (0; 1–10; 11–100; 101–400; 401–1,000; >1,000).ResultsThe prevalence of obstructive disease was 51% (23.5% single vessel; 27.5% multivessel; progressive increase from 17.9% to 94% through the CACS classes). In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 99%, 92%, 94% and 99%, respectively. Per-patient analysis showed a worse PPV of CTCA (76–77%) in classes with low CACS (1–10/11–100). Per-patient LR were higher in classes with extreme CACS values (0 = LR+ 18.3 and LR− = 0.0; c1,000 = LR+ 17.0 and LR− = 0.0) with values always >7 for LR+ and <0.033 for LR− for all CACS classes.ConclusionsCTCA is a reliable diagnostic modality, with high sensitivity and NPV regardless of CACS.RiassuntoObiettivoObiettivo del nostro lavoro è stato valutare l’accuratezza diagnostica dell’angiografia coronarica non invasiva con tomografia computerizzata (CTCA) nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥50%) confrontata con la coronarografia convenzionale (CAG) in base al valore di calcium score (CACS).Materiali e metodiSono stati inclusi 1500 pazienti (928 uomini, età media 58,2±12,5 anni) in ritmo cardiaco sinusale sottoposti a CTCA e CAG. L’accuratezza diagnostica è stata calcolata utilizzando la CAG come standard di riferimento. Sono state calcolate l’accuratezza diagnostica, i quozienti di probabilità (LR) per la popolazione totale e nelle differenti classi di CACS (0; 1–10; 11–100; 101–400; 401–1000; >1000).RisultatiLa prevalenza di malattia ostruttiva nella popolazione era del 51% (23,5% malattia mono-vasale; 27,5% multi-vasale; con aumento progressivo dal 17,9% al 94% nelle diverse classi di CACS). Nell’analisi per paziente la sensibilità, specificità, valore predittivo positivo e negativo della CTCA sono risultati 99%, 92%, 94%, 99%, rispettivamente. Nell’analisi per paziente la CTCA ha mostrato un valore predittivo positivo peggiore (76%–77%) nelle classi di CACS basso (1–10/11–100). I LR per paziente sono risultati più elevati nelle classi estreme di CACS (0, LR+=18,3 e LR−=0,0; >1000, LR+=17,0 e LR− =0,0) con valori sempre >7 per LR+ e <0,033 per LR−, per tutte le classi di CACS.ConclusioniLa CTCA è una metodica diagnostica affidabile con elevata sensibilità e valore predittivo negativo indipendentemente dal valore di CACS.