Exercise ultrafast computed tomography for the detection of coronary artery disease

Ultrafast computed tomography permits the assessment of global and regional left ventricular function during exercise. To evaluate the feasibility of using this new technique for the diagnosis of coronary artery disease, 27 patients undergoing cardiac catheterization for diagnosis of chest pain were evaluated. Fifteen patients had significant (>50%) coronary artery stenosis by quantitative coronary angiography. One vessel disease was found in 12 patients and multivessel disease in 3. Fourteen (93%) of the 15 patients with significant coronary stenosis had a decrease in ultrafast computed tomographic ejection fraction during exercise from (mean ± SD) 65 ± 7% to 60 ± 7% (p < 0.001). The tomographic ejection fraction increased >5% units during exercise in 10 (83%) of the 12 patients with normal coronary arteries. The mean tomographic ejection fraction in this group was 68 ± 6% at rest and 75 ± 6% at peak exercise (p < 0.001). Regional wall motion was quantified by analyzing the segmental ejection fraction of 12 30° pie segments at each tomographic level of the left ventricle. A new regional wall motion abnormality developed during exercise in 12 (86%) of 14 patients with coronary artery disease; one patient was excluded because of a technical problem in data storage. Eleven (93%) of the 12 patients with normal coronary arteries had normal wall motion during exercise. In no patient with ischemic heart disease were both variables, ejection fraction response and regional wall motion, normal. Exercise ultrafast computed tomography appears to be a useful technique for the evaluation of coronary artery disease in patients with chest pain and predominant single vessel coronary artery disease. Quantitative assessment of the regional wall motion is a promising method for detecting abnormal wall motion produced by exercise-induced ischemia.