Valerio Brambilla
University of Parma
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Valerio Brambilla.
Radiologia Medica | 2007
Filippo Cademartiri; Erica Maffei; Alessandro Palumbo; Roberto Malago; Fillippo Alberghina; Annachiara Aldrovandi; Valerio Brambilla; Giuseppe Runza; Ludovico La Grutta; Alberto Menozzi; Luigi Vignali; Giancarlo Casolo; Massimo Midiri; Nico R. Mollet
PurposeOur aim was to evaluate the diagnostic accuracy of 64-slice computed tomography coronary angiography (MSCT-CA) for detecting significant stenosis (≥50% lumen reduction) in a population of patients at low to intermediate risk.Materials and methodsWe studied 72 patients (38 men, 34 women, mean age 53.9±8.0 years) with atypical or typical chest pain and stratified in the low-to intermediate risk category. MSCT-CA (Sensation 64 Cardiac, Siemens, Germany) was performed after IV administration of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). Two observers, blinded to the results of conventional coronary angiography (CAG), assessed the MSCT-CA scans in consensus. Diagnostic accuracy for detecting significant stenosis was calculated.ResultsCAG demonstrated the absence of significant disease in 70.1% of patients (51/72). No patient was excluded from MSCT-CA. There were 37 significant lesions on 1,098 available coronary segments. Sensitivity, specificity and positive and negative predictive value of MSCT-CA for detecting significant coronary artery on a per-segment basis were 100%, 98.6%, 71.2% and 100%, respectively. All patients with at least one significant lesion were correctly identified by MSCT-CA. MSCT-CA scored 15 false positives on a per-segment base, which affected only marginally the per-p.atient performance (only one false positive).ConclusionsWe concluded that 64-slice CT-CA is a diagnostic modality with high sensitivity and negative predictive value in patients at low to intermediate risk.RiassuntoObiettivoValutare l’accuratezza diagnostica dell’angiografia coronarica non invasiva con tomografia computerizzata (AC-TC) a 64 strati nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥ 50%) in una popolazione di pazienti a basso-intermedio rischio cardiovascolare.Materiali e metodiSono stati studiati 72 pazienti (38 maschi, 34 donne, età media 53,9±8,0 anni) che presentavano dolore toracico atipico o angina pectoris stabile e che venivano stratificati nella categoria del rischio basso-intermedio. Per la scansione AC-TC sono stati iniettati endovena 100 ml di mezzo di contrasto (Iomeprolo 400 mgI/ml, Bracco, Italia). Due osservatori, in cieco rispetto alla coronarografia convenzionale CAG), hanno valutato in consenso le immagini dell’AC-TC. Sono stati quindi calcolati i valori di accuratezza diagnostica per la rilevazione di stenosi significative.RisultatiL’angiografia coronarica invasiva ha dimostrato l’assenza di malattia o la presenza di malattia non critica nel 70,1% dei pazienti (51/72). Nessun paziente è stato escluso dalla popolazione studiata. Sono state individuate 37 lesioni significative su 1098 segmenti disponibili. Sensibilità, specificità, valore predittivo positivo e negativo dell’AC-TC nella determinazione delle stenosi significative utilizzando un’analisi per segmenti sono risultate, rispettivamente, del 100%, 98,6%, 71,2% e 100%. Tutti i pazienti con almeno una lesione significativa sono stati correttamente identificati anche nella valutazione con AC-TC. L’AC-TC ha generato 15 falsi postivi su base segmentale che però si riducono a un solo falso positivo nell’analisi per paziente.ConclusioniL’AC-TC a 64 strati rappresenta una metodica diagnostica ad elevata sensibilità e valore predittivo negativo nei pazienti con rischio basso o intermedio.
European Radiology | 2009
A. Palumbo; Erica Maffei; Chiara Martini; Giuseppe Tarantini; Gian Luca Di Tanna; Elena Berti; Roberto Grilli; Giancarlo Casolo; Valerio Brambilla; Marcella Cerrato; Antonio Rotondo; Annick C. Weustink; Nico R. Mollet; Filippo Cademartiri
We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1–10, group 3: score 11–100, group 4: score 101–400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk.
Hypertension | 2005
Paolo Coruzzi; Gianfranco Parati; Lorenzo Brambilla; Valerio Brambilla; Massimo Gualerzi; Almerico Novarini; Paolo Castiglioni; Marco Di Rienzo
Salt-sensitive hypertensive subjects, as defined by conventional categorical classification, exhibit alterations of autonomic cardiovascular control. The aim of our study was to explore whether, in hypertensive subjects, the degree of autonomic dysfunction and the level of salt sensitivity are correlated even when the latter is only mildly elevated and displays under-threshold values. Salt sensitivity of 34 essential hypertensive subjects was assessed on a continuous basis by the salt sensitivity index after low- and high-sodium diet. Beat-by-beat finger blood pressure was recorded after each diet period. Autonomic cardiovascular control was evaluated by spectral analysis of blood pressure and pulse interval and by assessment of spontaneous baroreflex sensitivity (sequence technique). Salt sensitivity and baroreflex sensitivity showed a negative relationship during low and high sodium intake, starting from low values of the salt sensitivity index. All spectral indexes of pulse interval, except the ratio between low- and high-frequency powers, were inversely related to salt sensitivity index after high sodium intake. In subjects with lower salt sensitivity, baroreflex sensitivity and pulse interval power in the high-frequency band were higher after high sodium intake than after low sodium intake. In contrast, subjects with a higher salt sensitivity index showed lower values of baroreflex sensitivity and pulse interval power in the high-frequency band, uninfluenced by salt intake. Our results provide the first demonstration of an impairment of parasympathetic cardiac control in parallel with the increase in the degree of salt sensitivity, also in subjects who were not ranked as salt-sensitive by the conventional categorical classification.
Hypertension | 2011
Paolo Castiglioni; Gianfranco Parati; Lorenzo Brambilla; Valerio Brambilla; Massimo Gualerzi; Marco Di Rienzo; Paolo Coruzzi
Sodium sensitivity is an important cardiovascular risk factor for which a diagnosis requires a time-consuming protocol, the implementation of which is often challenging for patients and physicians. Our aim was to assess the reliability of an easier approach based on data from 24-hour ambulatory blood pressure monitoring performed in hypertensive subjects during daily-life conditions and habitual diet. We enrolled 46 mild to moderate hypertensive subjects who underwent 24-hour ambulatory blood pressure monitoring during usual sodium intake. Patients were divided into 3 classes of sodium sensitivity risk on the basis of ambulatory blood pressure monitoring data: low risk if dippers and a 24-hour heart rate ≤70 bpm; high risk if nondippers and a 24-hour heart rate of >70 bpm; intermediate risk with the remaining combinations (dippers with heart rate >70 bpm or nondippers with heart rate ≤70 bpm). Then patients underwent a traditional sodium sensitivity test for the dichotomous classification as sodium sensitive or sodium resistant and for evaluating the sodium sensitivity index. Prevalence of sodium-sensitive patients and mean value of sodium sensitivity index were calculated in the 3 risk classes. The sodium sensitivity index markedly and significantly increased from the low-risk to the high-risk class, being equal to 19.9±14.4, 37.8±8.3, and 68.3±17.0 mm Hg/(mol/day) in the low-risk, intermediate-risk, and high-risk classes, respectively (M±SEM). Also, the prevalence of sodium-sensitive patients increased significantly from the low-risk class (25%) to the intermediate-risk (40%) and high-risk (70%) classes. Thus, performance of 24-hour ambulatory blood pressure monitoring in daily-life conditions and habitual diet may give useful information on the sodium sensitivity condition of hypertensive subjects in an easier manner than with the traditional sodium sensitivity test approach.
Radiologia Medica | 2006
Filippo Cademartiri; Giuseppe Runza; Giacomo Luccichenti; Massimo Galia; Nico R. Mollet; Valerio Alaimo; Valerio Brambilla; Massimo Gualerzi; Paolo Coruzzi; Massimo Midiri; Roberto Lagalla
Conventional coronary angiography is the gold standard for the diagnosis of coronary artery anomalies. Coronary anomalies are relatively rare findings in patients undergoing conventional coronary angiography for suspected obstructive coronary artery disease. Recently, the increasing performance of diagnostic techniques, such as electron beam tomography (EBT), magnetic resonance (MR) and, more recently, multislice computed tomography (MSCT), has enabled their application to cardiac imaging. MSCT, in particular, has a prominent role in coronary imaging due to its spatial and temporal resolution and threedimensional capabilities. We report the incidence and pathophysiology of coronary artery anomalies based on the capabilities of recent diagnostic tools with the aim of improving an accurate and noninvasive diagnostic approach.
Radiologia Medica | 2008
Filippo Cademartiri; Sara Seitun; Matteo Romano; Erica Maffei; Michele Fusaro; Alessandro Palumbo; Annachiara Aldrovandi; Giancarlo Messalli; S. Tresoldi; Roberto Malago; Valerio Brambilla
PurposeThis study aimed to determine the prognostic value of coronary angiography with multislice computed tomography (MSCT) in a population of diabetic subjects with known or suspected ischaemic heart disease compared with a nondiabetic control population.Materials and methodsForty-nine patients with type 2 diabetes mellitus (DM) [group 1; mean age 67.7±8.8 years; 32 men; mean body mass index (BMI) 28±3.9] and 49 patients without DM (group 2, with similar demographic and clinical characteristics) were studied with MSCT coronary angiography to exclude the presence of ischaemic coronary artery disease (CAD). Each group comprised 26 patients (53%) with no history of ischaemic coronary disease and 23 patients (47%) with a history of myocardial infarction and/or myocardial revascularisation. Clinical follow-up was performed by analysing correlations between the rate of cumulative cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina, and myocardial revascularisation), the severity of CAD identified on MSCT, and the presence of DM as a cardiovascular risk factor.ResultsAt mean follow-up of 20 months, univariate analysis of survival showed significant differences between the two groups (group 1 vs. group 2, p=0.046). Moreover, the cumulative cardiac event rate correlated significantly with the presence of significant CAD (>50% stenosis) in both groups (group 1: p=0.003; group 2: p=0.0004).ConclusionsEvent-free survival is significantly lower in the diabetic population compared with the normal control population (p=0.046) and is closely correlated with the presence of significant CAD. MSCT is an effective method for stratifying such risk and, together with high diagnostic accuracy, provides additional prognostic value.RiassuntoObiettivoStudiare il valore prognostico della angiografia coronarica mediante TC multistrato (TCMS) in una popolazione di pazienti diabetici con nota o sospetta cardiopatia ischemica e in una popolazione non diabetica di confronto.Materiali e metodiQuarantanove pazienti con diabete mellito tipo-2 (DM), gruppo I, (età media: 67,7±8,8 anni; maschi 32; BMI medio: 28±3,9) e 49 pazienti senza DM, gruppo II, con sovrapponibili caratteristiche demografiche e cliniche, sono stati sottoposti a studio coronarografico con TCMS per escludere la presenza di coronaropatia ischemica. Relativamente ad ogni gruppo, 26 pazienti (53%) erano senza storia di cardiopatia ischemica, mentre 23 (47%) avevano storia di pregresso infarto miocardico e/o rivascolarizzazione miocardica. Abbiamo condotto un follow-up clinico analizzando la correlazione fra il tasso di eventi cardiaci cumulativi (morte cardiaca, infarto miocardico non fatale, angina instabile e rivascolarizzazioni miocardiche) e la severità della coronaropatia riscontrata alla TCMS e la presenza del DM come fattore di rischio cardiovascolare.RisultatiAl follow-up medio di 20 mesi, l’analisi univariata della sopravvivenza ha mostrato differenze significative nel confronto fra i gruppi (gruppo I vs. gruppo II, p=0,046). Inoltre, il tasso di eventi cardiaci cumulativi è risultato significativamente correlato alla presenza di malattia significativa (stenosi >50%) in entrambi i gruppi (gruppo I: p=0,003; gruppo II: p=0,0004).ConclusioniLa sopravvivenza libera da eventi cardiaci è significativamente più bassa nella popolazione diabetica rispetto alla popolazione normale di controllo (p=0,046) ed è strettamente correlata alla presenza di malattia significativa. La TCMS è una metodica efficace nella stratificazione del rischio e, insieme all’accuratezza diagnostica, offre un valore prognostico aggiunto.
Radiologia Medica | 2007
Filippo Cademartiri; Roberto Malago; L. La Grutta; Fillippo Alberghina; Alessandro Palumbo; Erica Maffei; Valerio Brambilla; Francesca Pugliese; Giuseppe Runza; Massimo Midiri; Nico R. Mollet; Gabriel P. Krestin
PurposeThis paper aims to provide the tools for a complete anatomical evaluation of the coronary tree using 64-slice computed tomography (CT) and evaluate the prevalence of anatomical variants and anomalies in a population of 202 consecutive patients.Materials and methodsTwo hundred and two patients with suspected coronary artery disease underwent 64-slice CT with a standard protocol. Two observers working in consensus evaluated and collected the data regarding anatomical variants and anomalies of the coronary vessels.ResultsIn the 202 consecutive patients, the prevalence of anatomical variants was: left dominant circulation (7%), absent left main (5%), presence of intermediate branch (17%), aortic origin of conus branch (13%) and circumflex origin of sinus node branch (15%). Coronary anomalies (origin and course, intrinsic and termination) showed an overall prevalence of 25%.ConclusionsCT is the ideal method for the three-dimensional evaluation of the coronary tree. Anatomical variants and anomalies of the coronary arteries are quite common and should be known and recognised promptly by the operators.RiassuntoObiettivoFornire gli strumenti per una completa valutazione anatomica del circolo coronarico mediante TC a 64 strati e valutare la prevalenza di varianti ed anomalie in una popolazione di 202 pazienti consecutivi.Materiali e metodiDuecentodue pazienti con sospetta malattia coronarica sono stati sottoposti a TC delle coronarie a 64 strati con protocollo standard. Due osservatori in consenso hanno valutato la presenza di varianti anatomiche e anomalie dei vasi coronarici.RisultatiNei 202 pazienti consecutivi arruolati per lo studio la prevalenza delle varianti anatomiche è risultata: dominanza sinistra (7%), tronco comune assente (5%), presenza di ramo intermedio (17%), origine aortica del ramo del cono (13%), origine dalla circonflessa dell’arteria del nodo del seno (15%). Le anomalie coronariche di origine e decorso, intrinseche e di terminazione hanno mostrato una prevalenza complessiva del 25%.ConclusioniLa TC è uno strumento ideale per la valutazione tridimensionale del circolo coronarico. Le varianti e le anomalie coronariche sono un reperto molto comune che deve quindi essere riconosciuto agevolmente dall’operatore.
European Journal of Clinical Investigation | 2007
Paolo Coruzzi; Paolo Castiglioni; Gianfranco Parati; Valerio Brambilla; Lorenzo Brambilla; Massimo Gualerzi; Filippo Cademartiri; A. Franzè; G. De Angelis; M. Di Rienzo; F. Di Mario
Background In inflammatory bowel diseases, changes in autonomic enteric regulation may also affect neural cardiovascular control. However, while cardiac autonomic modulation has been shown to be impaired in active ulcerative colitis, the occurrence of cardiovascular autonomic alterations, also in the quiescent phase of inflammatory bowel diseases, is still a matter of debate. The aim of our study was thus to explore the features of cardiovascular autonomic regulation in ulcerative colitis and Crohns disease during their remission phase.
Radiologia Medica | 2008
Filippo Cademartiri; Matteo Romano; Sara Seitun; Erica Maffei; Alessandro Palumbo; Michele Fusaro; Annachiara Aldrovandi; Giancarlo Messalli; S. Tresoldi; Roberto Malago; Ludovico La Grutta; Giuseppe Runza; Valerio Brambilla; Carlo Tedeschi; Giancarlo Casolo; Massimo Midiri; Nico R. Mollet
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
Radiologia Medica | 2010
Erica Maffei; Alessandro Palumbo; Chiara Martini; A. Cuttone; Fabrizio Ugo; E. Emiliano; Alberto Menozzi; Luigi Vignali; Valerio Brambilla; Paolo Coruzzi; Annick C. Weustink; Nico R. Mollet; Diego Ardissino; Claudio Reverberi; Girolamo Crisi; Filippo Cademartiri
PurposeThis study aimed to evaluate the diagnostic accuracy of stress electrocardiogram (ECG) and computed tomography coronary angiography (CTCA) for the detection of significant coronary artery stenosis (≥50%) in the real world using conventional CA as the reference standard.Materials and methodsA total of 236 consecutive patients (159 men, 77 women; mean age 62.8±10.2 years) at moderate risk and with suspected coronary artery disease (CAD) were enrolled in the study and underwent stress ECG, CTCA and CA. The CTCA scan was performed after i.v. administration of a 100-ml bolus of iodinated contrast material. The stress ECG and CTCA reports were used to evaluate diagnostic accuracy compared with CA in the detection of significant stenosis ≥50%.ResultsWe excluded 16 patients from the analysis because of the nondiagnostic quality of stress ECG and/or CTCA. The prevalence of disease demonstrated at CA was 62% (n=220), 51% in the population with comparable stress ECG and CTCA (n=147) and 84% in the population with equivocal stress ECG (n=73). Stress ECG was classified as equivocal in 73 cases (33.2%), positive in 69 (31.4%) and negative in 78 (35.5%). In the per-patient analysis, the diagnostic accuracy of stress ECG was sensitivity 47%, specificity 53%, positive predictive value (PPV) 51% and negative predictive value (NPV) 49%. On stress ECG, 40 (27.2%) patients were misclassified as negative, and 34 (23.1%) patients with nonsignificant stenosis were overestimated as positive. The diagnostic accuracy of CTCA was sensitivity 96%, specificity 65%, PPV 74% and NPV 94%. CTCA incorrectly classified three (2%) as negative and 25 (17%) as positive. The difference in diagnostic accuracy between stress ECG and CTCA was significant (p<0.01).ConclusionsCTCA in the real world has significantly higher diagnostic accuracy compared with stress ECG and could be used as a first-line study in patients at moderate risk.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’accuratezza diagnostica dell’elettrocardiogramma sotto stress (stress-ECG) e dell’angiografia coronarica con tomografia computerizzata (CT-CA) nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥50%) vs l’angiografia coronaria convenzionale (CAG) basando la valutazione sulla refertazione clinica.Materiali e metodiDuecentotrentasei pazienti consecutivi (159 maschi, 77 femmine, età media 62,8±10,2 anni) a rischio intermedio con sospetta malattia coronarica sono stati arruolati per lo studio e sottoposti a stress-ECG, CT-CA e CAG. Per la scansione CT-CA sono stati iniettati endovena 100 ml di mezzo di contrasto. Tutti i pazienti sono stati quindi sottoposti a CAG. I referti dello stress-ECG e della CT-CA sono stati confrontati con la CAG quantitativa per la valutazione dell’accuratezza diagnostica.RisultatiSedici pazienti sono stati esclusi dall’analisi per stress-ECG e/o CT-CA di qualità inadeguata. La prevalenza di malattia è risultata del 62% nella popolazione complessiva (n=220), del 51% nella popolazione con stress-ECG e CT-CA confrontabili (n=147), e dell’84% nella popolazione con stress-ECG dubbio (n=73). Settantatre (33,2%) stress-ECG sono stati classificati come dubbi, 69 (31,4%) sono stati classificati come positivi e 78 (35,5%) sono stati classificati come negativi. Nell’analisi per paziente i valori dell’accuratezza diagnostica dello stress-ECG sono risultati: sensibilità 47%, specificità 53%, valore predittivo positivo 51%, valore predittivo negativo 49%. Quaranta (27,2%) pazienti sono stati erroneamente classificati come negativi. Trentaquattro (23,1%) pazienti che non avevano stenosi significative sono stati incorrettamente classificati come positivi. I valori dell’accuratezza diagnostica della CT-CA sono risultati: sensibilità 96%, specificità 65%, valore predittivo positivo 74%, valore predittivo negativo 94%. Tre (2%) pazienti sono stati erroneamente classificati come negativi. Venticinque (17%) pazienti che non avevano stenosi significative sono stati incorrettamente classificati come positivi. La differenza di accuratezza diagnostica è risultata significativa (p<0,01).ConclusioniLa CT-CA nel mondo reale mostra una accuratezza diagnostica significativamente superiore allo stress-ECG e potrebbe essere utilizzata in prima istanza nei pazienti a rischio intermedio.