Invasive Versus Noninvasive Evaluation of Coronary Artery Disease
Joanne D. Schuijf, PhD*,
Jacob M. van Werkhoven, MSc*, ,
Gabija Pundziute, MD*,
J. Wouter Jukema, MD, PhD*,,
Isabel Decramer, MSc||,
Marcel P. Stokkel, PhD, MD ,
Petra Dibbets-Schneider, MSc,
Martin J. Schalij, MD, PhD*,
Johannes H.C. Reiber, PhD ,
Ernst E. van der Wall, MD, PhD,
William Wijns, MD, PhD||,
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
|| The Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
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Figure 1 MDCT and QCA Findings in 70 Patients With Abnormal and Normal MPI Results, Respectively
Note the discrepancy between the imaging modalities in patients with normal myocardial perfusion imaging (MPI). In most of these patients, multidetector computed tomography (MDCT) was abnormal, with no significant difference in the number of segments with atherosclerosis either (as compared with patients with abnormal perfusion. However, number of significantly stenosed segments was significantly lower in patients with normal MPI, as also reflected by minimal luminal narrowing on quantitative coronary angiography (QCA). *Average in patients with atherosclerosis on MDCT.
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Figure 2 MPI, MDCT, and QCA Observations in 49 Patients in Whom Additional IVUS Imaging Was Performed
In almost all patients with normal MPI, the presence of atherosclerosis was observed on MDCT with negligible luminal narrowing identified on QCA. Intravascular ultrasound (IVUS) imaging confirmed the presence of substantial atherosclerosis (mean lesion plaque burden 58.9%), yet without luminal compromise (mean minimal lumen area [MLA] 5.8 mm2). Abbreviations as in Figure 1.
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Figure 3 Coronary Artery Disease by MDCT Coronary Angiography With Normal Myocardial Perfusion
A 60-year old male presented to the outpatient clinic with dyspnea and an elevated risk profile for coronary artery disease, including hypertension, hypercholesterolemia, and smoking. Contrast-enhanced multidetector computed tomography (MDCT) coronary angiography revealed considerable atherosclerosis in the left anterior descending coronary artery (A). B and C are cross-sectional images of the areas indicated by the arrows in (A). In contrast, myocardial perfusion imaging (D), which was performed during exercise stress (first and third row) and rest (second and fourth row), showed normal perfusion. On intravascular ultrasound imaging (E and F), considerable plaque burden was demonstrated, yet with preserved coronary lumen.
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Figure 4 Differences in IVUS Measurements Between Coronary Arteries With CAD and Without CAD as Determined on MDCT
(A) MLA (mm2) and corrected lumen area stenosis (%) and (B) plaque area (mm2) and plaque burden (%). All measurements were significantly different between coronary arteries with and without coronary artery disease (CAD) identified on MDCT. Abbreviations as in Figures 1 and 2.
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