Published Online
on March 24, 2009

A more recent version of this article appeared on May 1, 2009

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Original Article

Sixty-four-slice Multidetector Computed Tomography: An Accurate Imaging Modality for the Evaluation of Coronary Arteries in Dilated Cardiomyopathy of Unknown Etiology

Daniele Andreini^1,3; Gianluca Pontone¹; Antonio L. Bartorelli¹; Piergiuseppe Agostoni¹; Saima Mushtaq¹; Erika Bertella¹; Daniela Trabattoni¹; Gaia Cattadori¹; Sarah Cortinovis¹; Andrea Annoni¹; Alice Castelli²; Giovanni Ballerini¹ and Mauro Pepi¹

¹ Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy;
² San Paolo Hospital, University of Milan, Milan, Italy

³ E-mail: daniele.andreini{at}ccfm.it

Background—The goal of this study was to assess the safety, feasibility, and diagnostic accuracy of 64-slice multidetector computed tomography (MDCT) for the evaluation of coronary arteries in dilated cardiomyopathy (DCM) of unknown etiology. Sixteen-slice MDCT is useful in patients affected by DCM. However, technical limitations, such as an inability of patients to sustain a long breath-hold and cardiac arrhythmias, and the need of a high dose of contrast agent may limit its accuracy and widespread use.

Methods and Results—Invasive coronary angiography (ICA) and MDCT coronary angiography were performed on 132 consecutive patients (82 men; age 63±11 years) affected by DCM (ejection fraction 34±10%) of unknown etiology. In two patients (1.5%), MDCT was not feasible because of atrial fibrillation. Of the remaining 130 patients, 88 exhibited normal and 42 exhibited diseased coronary arteries in both MDCT and ICA. All patients with coronary artery disease, but one, were correctly classified by MDCT as 1-vessel (11 cases), 2-vessel (13 cases), and 3-vessel (18 cases) disease. In the segment-based analyses, the overall feasibility for MDCT was 98.5% (1902 out of 1930 segments). Segment-based and patient-based analysis for the detection of luminal stenosis of more than 50% and more than 70% were performed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for the detection of >50% stenosis were 98.1%, 99.9%, 98.7%, 99.8%, and 99.7%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for the detection of >70% stenosis were 99.5%, 98.6%, 94.1%, 99.9% and 99.4%, respectively.

Conclusions—Excellent feasibility and diagnostic accuracy, combined with low invasiveness, make 64-slice MDCT an ideal imaging modality for the anatomic evaluation of coronary circulation in patients with DCM of unknown etiology.

Key Words: angiography • cardiomyopathy • coronary disease • heart failure • imaging • tomography • 64-slice multidetector

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