Abstract 13377: A Multicenter Study of 320 Slice CT in Chronic Atrial Fibrillation: A Comparison of Prospective and Retrospective ECG Gating
Purpose: To compare diagnostic accuracy of prospective and retrospective ECG gating in 320 slice CT for detecting coronary stenosis in patients with chronic atrial fibrillation (CAF) in a multicenter study.
Methods: A total of 53 CAF patients who underwent 320 slice CT, and conventional coronary angiogram (CAG) within 6 months (43 male; 69 ± 9 yrs; CHADS2 score 2.2 ± 1.3; CHA2DS2-VASc score 3.5 ± 1.6) in the two Institutes were analyzed. In Institute 1, prospective ECG-gated acquisition was routinely performed (N=33). In Institute 2, retrospective ECG-gated acquisition was routinely performed + added prospective ECG-gated acquisition in late phase to detect thrombi (N=20). CT and CAG data were transferred to the analysis center and were analyzed by cardiologists blinded to the clinical data.
Results: Prevalence of >50, >75% on CAG was 79, 61% in Institute 1, 30, 15% in Institute 2, respectively. In a patient by patient analysis, Institute 2 had higher negative predictive value (NPV) and accuracy of >75% stenosis on CT in predicting >75% stenosis on CAG. In a vessel by vessel analysis, there were no significant differences of sensitivity, specificity, positive predictive value (PPV) and NPV of >50% stenosis on CT in predicting >50% stenosis on CAG between both groups. But sensitivity, specificity, and NPV of >75% stenosis on CT in predicting >75% stenosis on CAG were significantly higher in Group 2 than Group 1. This is mainly because of more severe coronary artery disease including calcification in Institute 1; there might also have been an influence of differences in scanning and reconstruction methods.
Conclusions: 320 slice CT shows relatively high diagnostic accuracy for the detection of significant coronary artery stenosis compared with CAG even in CAF subjects, in a multicenter analysis. Retrospective ECG-gated acquisition in 320 slice CT shows significantly higher diagnostic accuracy than prospective ECG gating for detection of >75% coronary artery stenosis.
- © 2013 by American Heart Association, Inc.