by Karl Loren
While the recognized "gold standard" for detecting atherosclerotic plaque is the use of coronary angiography and intravascular ultrasound (IVUS), Electron Beam Computed Tomography (EBCT) has been recognized as an effective noninvasive tool for detecting calcification in coronary arteries. EBCT can visualize, localize and quantify the process of atherosclerosis; coronary angiography describes advanced changes in atherosclerosis, and IVUS detects the early stages of the disease and characteristics of the plaque. Results of the first study comparing this noninvasive tool with the two more established methods were published in the July 1997 issue of the Journal of the American College of Cardiology.
Researchers at the University of Essen in Germany analyzed 267 artery segments of 57 patients, (average age of 54) who had been suspected of having heart disease. Through the procedures used during the study, 29 of the patients were diagnosed with coronary artery disease in at least one vessel.
Findings indicated that EBCT detected calcified plaques with a high degree of accuracy: "Compared with coronary angiography, EBCT yielded a sensitivity of 66%, a specificity of 78%, a positive predictive value of 39% and a negative predictive value of 91%." Therefore, negative EBCT results were extremely accurate for those patients who did not have any "significant" evidence of heart disease. Compared with IVUS, its overall accuracy rate was 81% (overall sensitivity of 66% and specificity of 88%). EBCT detected plaques with ultrasound signs of calcification with the highest sensitivity and specificity compared with that for coronary angiography and ICUS. According to the journal article, "Early signs of atherosclerosis (i.e., soft plaques without apparent ultrasound signs of calcification on ICUS) can also be detected by EBCT but with lower sensitivity than for calcified plaques but equivalent specificity."
See also articles:
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Cholesterol Lowering For Those
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First Large Study Suggests 'Ultrafast CT' Can Accurately Detect Coronary Disease
Heart Disease Prevention: Who
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HeartInfo Editorial Comment:
This new study confirms that EBCT detects calcified plaque with a high degree of
accuracy. When calcification is present, plaque is present and the overall
amount of calcification strongly correlates with the total amount of plaque
burden. Not all plaques are detected by EBCT if they are not calcified, so a
negative result on EBCT should not be used to exclude coronary disease in
someone who has a high clinical suspicion for having disease. On the other hand,
a negative result has a very high predictive value for the absence of
"significant" coronary disease. Conversely, a substantial amount of
calcification indicates a plaque burden that may be a reason for more aggressive
risk factor intervention. EBCT should not be thought of as a
"diagnostic" test, but rather as a test that helps to predict risk of
developing future clinical heart disease.
SOURCES: Journal of the American College of Cardiology, Vol. 30, No. 1, July 1997:57-64, "Comparison of Electron Beam Computed Tomography With Intracoronary Ultrasound and Coronary Angiography for Detection of Coronary Atherosclerosis"; Wall Street Journal, July 9, 1997, "Imatron Ultrafast CT Detects Heart Disease Before Narrowing".
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