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The use of Cardiac Computed Tomography Angiography (CCTA) to distinguish ischemic vs non-ischemic etiology in newly diagnosed heart failure patients with low to intermediate probability of coronary artery disease (CAD) is an appropriate indication (appropriateness score = 7) according to the current guidelines, however, larger scale studies in further support of this are needed.
We included 55 patients who had been referred to our institution for a CCTA for evaluation of known or suspected new onset heart failure. The diagnostic accuracy of 64 slice multi-detector CCTA to detect ischemic vs non-ischemic cardiomyopathy (CM) with invasive coronary angiography as the reference were calculated.
Mean age of the patients was 59.7 ± 9.4 years (98.2% males) and the Left Ventricular (LV) ejection fraction by echo and CCTA were calculated to be 23.6 ± 11.1% and 31.9 ± 11.2% respectively. Out of the total 55 patients; 50.9% were diagnosed as ischemic CM versus 49.1% non-ischemic as per CCTA. Of the 55 patients, 26 underwent cardiac catheterization as part of their work up; and 23.1% were diagnosed as nonischemic CM and the remaining as ischemic CM. Taking cardiac catheterization as the reference standard, CCTA had a Sensitivity of 100%, Specificity of 83.3%, Positive predictive value of 95.2%, and Negative predictive value of 100% of diagnosing ischemic DCM. As per the discharge diagnosis, the etiologies of non-ischemic CM were arrhythmia induced (3.6%); end-stage renal disease (1.8%); alcohol (9.1%); HTN (9.1%); sepsis (1.8%); valve disease (9.1%); and idiopathic (3.6%). We assessed the association of global versus segmental wall motion abnormalities by echo with obstructive CAD by CCTA and found no significant association with RR 1.06, 95% CI [0.55-2.04].
CCTA is a highly accurate non-invasive diagnostic modality to exclude ischemic etiology in patients with new onset or newly diagnosed heart failure, further supporting the current appropriateness criteria. Appropriate use of CCTA in this patient population can reduce unnecessary cardiac catheterization procedures and its related complications.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Multimodality Imaging in Cardiomyopathy
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1316-365
- 2013 American College of Cardiology Foundation