Keywords:
Arteriosclerosis, Diagnostic procedure, CT, Cardiac
Authors:
C. Grippo1, C. Rutigliano1, D. Curione2, D. V. Di Molfetta2, G. Savino2, R. Marano1, L. Bonomo1; 1Rome/IT, 2Roma/IT
Results
- The CN group showed higher rates of significant coronary stenosis at MDCT-CA in comparison with the DN group (p<0.001) (Fig.
2);
- No significant differences resulted in CACS between the two groups (p=0.980) (Fig.
3),
nor did CACS distribution for coronary stenosis ≥ or < 50% in all subjects (p =0.814), inpatients with CN (p=0.661) or with DN (p=0.559) (Fig.
4);
- The different classes of CACS (low/mild vs moderate/severe) showed a direct correlation with both the carotid (p=0.001) and the lower limb district CS (p=0.0014);
- No significant differences were found in the carotid and lower limb district CS distribution betweent the two groups (p=0.575 and 883,
respectively) (Fig.
5).
Our study shows that patients with CN have a higher prevalence of severe CAD in comparison with DN,
but their coronary plaques do not exhibit an increased degree of calcium: this might be explained by inflammation and endothelial dysfunction linked to an over-expression of several cytokines and procoagulant molecules in CN subjects [17-20]; furthermore,
the spatial resolution of MDCT-CA is not currently able to distinguish between calcifications within the atherosclerotic plaque from those within the tunica media of the arterial wall,
a factor possibly contributing to the lack of calcium score differences between the two groups.
- In the CN group, MDCT-CA showed a diagnostic accuracy (DA) for the detection of significant CAD of 82%, with a sensitivity,
specificity,
positive (PPV), and negative predictive values (NPV) of 100%,
70%,
70%, and 100%,
respectively;
- In the DN group,
MDCT-CA showed a DA of 92%,
with a sensitivity,
specificity,
PPV,
and NPV of 100%,
90%,
67%,
and 100%,
respectively;
- The overall DA of MDCT-CA was 87%, with a sensitivity,
specificity,
PPV,
and NPV of 100%,
82%,
69%,
and 100%, respectively (Table 2).
Limitations:
- small population;
- single-centre study;
- AS is commonly used for evaluating the coronary arteries,
while only limited investigations used this method on carotid and lower limb calcifications [21–23],
although atherosclerosis in these districts often shares the same risk factors and patient population as CAD;
- retrospective ECG-gating technique exposed patients to a considerable radiation dose.