Impact of hypertension on the diagnostic accuracy of coronary angiography with computed tomography

Husmann, Lars ; Scheffel, Hans ; Valenta, Ines ; Schepis, Tiziano ; Gaemperli, Oliver ; Aepli, Ursina ; Siegrist, Patrick ; Leschka, Sebastian ; Desbiolles, Lotus ; Stolzmann, Paul ; Marincek, Borut ; Alkadhi, Hatem ; Kaufmann, Philipp

In: The International Journal of Cardiovascular Imaging, 2008, vol. 24, no. 7, p. 763-770

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    Summary
    Objective Hypertension induces coronary artery disease (CAD) and progression of arterial wall calcification. As coronary calcifications may cause artefacts in 64-slice computed tomography coronary angiography (CTCA), we sought to determine the diagnostic accuracy of CTCA in patients with and without arterial hypertension. Methods Eighty-five consecutive patients with suspected CAD underwent CTCA, calcium-scoring and conventional coronary angiography, and were grouped as hypertensive (28 women, 31 men, mean age 65±9years, age range 49-82years) or normotensive patients (10 women, 16 men, mean age 62±11years, age range 39-77years). On an intention-to-diagnose-basis, no coronary segment was excluded and non-evaluative segments were rated as false positive. Results Per-patient sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in the hypertensive group were 91.4, 83.3, 88.9, and 86.9%, while the respective values in the normotensive group were 100, 78.9, 63.6, and 100% (P=0.42, 0.71, 0.05, and 0.15). In the hypertensive group the prevalence of CAD was 59% and the mean calcium-score was 256; respective values in the normotensive group were 27% and 69, (P<0.01, and<0.05 vs. hypertensives). Conclusions Although hypertensives have significantly higher coronary calcifications, sensitivity and specificity are comparably high as in normotensives. The prevalence of CAD is higher in hypertensives and brings about a trend towards a lower NPV and a higher PPV