Optimal ECG trigger point in electron-beam CT studies: three methods for minimizing motion artifacts

The authors hypothesized that electrocardiographic triggering near end systole could minimize motion artifacts in electron-beam computed tomography (CT) of the coronary artery.

The study included 2,660 patients who underwent coronary artery calcium scanning with electron-beam CT. Trigger times were as follows: end of T wave, 120 to 25 msec before end of T wave, 25-50 msec after end of T wave, 40%, 45%, 50%, 55%, 60%, 70%, 75%, 80%, 90%, and 100% of R-R interval. The authors divided each group into seven subgroups according to heart rate. The percentages of cases with motion artifact in the right coronary artery were computed. Optimal trigger times were defined for each group, as well as for scan acquisitions of 250 and 200 msec.

The optimal trigger times were as follows for heart rates of less than 50, 51-60, 61-70, 71-80, 81-90, 91-100, and more than 100 beats per minute, respectively: for 100-msec scans, 359 (27% of the R-R interval), 228 (31%), 314 (34%), 304 (38%), 289 (41%), 283 (45%), and 274 msec (48%) after the R wave; for 250-msec scans, 840 (63%), 654 (60%), 240 (26%), 224 (28%), 219 (31%), 208 (33%), and 200 msec (35%) after the R wave; and for 200-msec scans, 722 (65%), 687 (63%), 249 (27%), 248 (31%), 244 (35%), 233 (37%), and 223 msec (39%) after the R wave.

The use of these new electrocardiographic triggers before end systole yielded the lowest percentage of motion artifacts (<3% across all heart rates), much lower than for conventional triggers (51% of cases with motion artifact for 80% trigger, P < .001).