The value of electrocardiography-gated multi-slice computed tomography in the evaluation of patients with chest pain.

BACKGROUND Multi-detector spiral computed tomography with retrospective electrocardiography-gated image reconstruction allows detailed anatomic imaging of the heart, great vessels and coronary arteries in a rapid, available and non-invasive mode. OBJECTIVES To investigate the spectrum of findings in 32 consecutive patients with chest pain who underwent CT coronary angiogram in order to determine the clinical situations that will benefit most from this new technique. METHODS Thirty-two patients with chest pain were studied by MDCT using 4 x 1 mm cross-sections, at 500 msec rotation with pitch 1-1.5, intravenous non-ionic contrast agent and a retrospectively ECG-gated reconstruction algorithm. The heart anatomy was evaluated using multi-planar reconstructions in the axial, long and short heart axes planes. Coronary arteries were evaluated using dedicated coronary software and the results were compared to those of conventional coronary angiograms in 12 patients. The patients were divided into four groups according to the indication for the study: group A--patients with high probability for coronary disease; group B--patients after CCA with undetermined diagnosis; group C--patients after cardiac surgery with possible anatomic derangement; and group D--symptomatic patients after coronary artery bypass graft, before considering conventional coronary angiography. RESULTS Artifacts caused by coronary motion, heavy calcification and a lumen diameter smaller than 2 mm were the most frequent reasons for non-evaluable arteries. Assessment was satisfactory in 83% of all coronary segments. The overall sensitivity of 50% stenosis was 74% (85% for main vessels) with a specificity of 96%. Overall, the CTCA results were critical for management in 18 patients. CONCLUSIONS Our preliminary experience suggests that CTCA is a reliable and promising technique for the detection of coronary artery stenosis as well as for a variety of additional cardiac and coronary structural abnormalities.