Coronary Artery Disease Clinical Trial
Official title:
Combined Use of Coronary MDCTA, Coronary Doppler Ultrasonography and PET Perfusion in Diagnosis of Coronary Artery Disease
Multislice CT angiography is a novel but already established and widely used in diagnosing
coronary artery disease (CAD). It is very reliable in ruling out hemodynamically significant
narrowings in coronary arteries (Negative predictive value). However, it may overestimate
the severity of the stenoses in up to 30% of the coronary artery lesions (positive
predictive value 70%). However, when coupled with a functional or flow-sensitive diagnostic
test, such as PET perfusion or coronary doppler ultrasonography, one can assume that even
the PPV may be as high as 95 %. Despite this assumption, there`s no scientific evidence to
support use of such hybrid multi-modality tests at present.
The investigators hypothesis is that improving the diagnostic accuracy of non-invasive
diagnosis of coronary artery disease will decrease the proportion of patients that need
catheter angiographies. The avoidance of these unnecessary invasive procedures will improve
patients´ quality of life and may even redirect health care resources in a more efficient
way.
Coronary MDCTA (multi-detector CT angiography) is a novel but already established and
widespread diagnostic method to diagnose coronary artery disease. When performed with a
64-detector (slice) CT, its strength is an excellent negative predictive value, NPV (98%).
Specificity (86%) is good but the positive predictive value (PPV) is only moderate (70%).
This is due to the ability of MDCTA to detect even minor vessel wall changes before they are
functionally significant, and the tendency of CT to overestimate the volume of dense
calcifications. However, when coupled with a functional or flow-sensitive diagnostic test,
such as PET perfusion or coronary doppler ultrasonography, one can assume that even the PPV
may be as high as 95 %. Despite this assumption, there`s no scientific evidence to support
use of such hybrid multi-modality tests at present.
Our hypothesis is that improving the diagnostic accuracy of non-invasive diagnosis of
coronary artery disease will decrease the proportion of patients that need catheter
angiographies. The avoidance of these unnecessary invasive procedures will improve patients´
quality of life and may even redirect health care resources in a more efficient way.
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