Abstract 2546: Resting Regional Left Ventricular Function as Assessed using Cardiac 64-slice Computed Tomography to Predict Acute Coronary Syndrome in Patients with Acute Chest Pain
Background: Cardiac computed tomography based noninvasive assessment of coronary atherosclerotic plaque and stenosis may be useful to improve risk stratification of patients with acute chest pain. Our goal was to determine the diagnostic accuracy of regional LV dysfunction assessed by MDCT for ACS in patients with acute chest pain but normal initial biomarkers and non-ischemic ECG.
Methods: We included consecutive subjects without a known history of MI or left ventricular dysfunction who presented to the emergency department (ED) with acute chest pain but had negative initial troponin and no ischemic ECG changes. All subjects underwent standard contrast-enhanced 64-slice cardiac MDCT (0.6mm slice thickness, 120 kVp, 850 mAs) within = hours of presentation. Images were reconstructed at 10% intervals throughout the cardiac cycle and analyzed using short and long axis cine images of the LV cavity created with four-dimensional viewing software. All MDCT scans were assessed qualitatively for regional LV function using the AHA/ACC 17-segment model independently by two experienced readers, who were blinded to the clinical course and coronary plaque and stenosis findings.
Results: One-hundred and seventy-three consecutive patients (mean age 56.2 ± 14 years, 56% male) were included. Twenty-two of these patients were ultimately diagnosed with ACS (MI 5, UAP 17) during their index hospitalization. Overall, 23 patients had impaired regional LV function, 17 of them had ACS (MI 5, UAP 12). The specificity (96%) and negative predictive value (96.6 –100%) for detection of ACS was excellent, even when patients with MI or UAP were excluded from subanalysis. Findings are summarized in table 1⇓.
Conclusion: The absence of regional LV dysfunction at rest by MDCT has a excellent specificity for ACS in patients without a known history of CAD who present with acute chest pain of uncertain origin. This information may be complimentary to the detection of coronary plaque and stenosis.