Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Coronary Computed Tomography Angiography for the Diagnosis of Vasospastic Angina: Comparison with Invasive Coronary Angiography and Ergonovine Provocation Test

  • Jiesuck Park (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital) ;
  • Hyung-Kwan Kim (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital) ;
  • Eun-Ah Park (Department of Radiology, Seoul National University Hospital) ;
  • Jun-Bean Park (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital) ;
  • Seung-Pyo Lee (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital) ;
  • Whal Lee (Department of Radiology, Seoul National University Hospital) ;
  • Yong-Jin Kim (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital) ;
  • Dae-Won Sohn (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital)
  • Received : 2018.12.03
  • Accepted : 2019.01.11
  • Published : 2019.05.01
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Abstract

Objective: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. Materials and Methods: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAGEPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. Results: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m2, and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. Conclusion: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.

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