Noninvasive Evaluation of the Coronary Arteries With Multislice Computed Tomography in Hypertensive Patients

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Abstract
Because patients with hypertension are at increased risk for coronary artery disease, early and noninvasive identification of the disease in patients with hypertension is important. Recently, multislice computed tomography (MSCT) has been demonstrated to allow both noninvasive coronary angiography and assessment of left ventricular function. The purpose of the present study therefore was to demonstrate the feasibility of this approach in patients with hypertension with known or suspected coronary artery disease and to compare the results to invasive coronary angiography and 2-dimensional echocardiography, respectively. MSCT was performed in 31 patients with confirmed hypertension. From the MSCT images, the presence of significant coronary stenoses (≥50% luminal narrowing) and regional wall motion abnormalities were evaluated and compared with invasive coronary angiography and 2-dimensional echocardiography. In addition, left ventricular ejection fraction was calculated from the MSCT images. A total of 243 (88%) coronary artery segments could be evaluated with MSCT. Sensitivity and specificity for the detection of significant coronary artery stenoses were 93% and 96%. On a per-patient basis, MSCT was accurate in 28 (90%) patients. Mean left ventricular ejection fraction was 46±14% (range, 16% to 64%). The agreement for assessing regional wall motion was 91% (kappa statistic, 0.81). In conclusion, simultaneous, noninvasive evaluation of coronary artery stenoses and left ventricular function with MSCT is accurate in patients with hypertension. This noninvasive approach may allow triage of patient treatment in terms of conservative versus invasive management.

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