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Non-invasive coronary angiography with multislice spiral computed tomography: impact of heart rate
K Nieman1, B J Rensing, R-J M van Geuns
1Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands. koennieman@hotmail.com
Insights
Higher heart rates significantly decrease the diagnostic accuracy of multislice spiral computed tomography (MSCT) coronary angiography. Lower heart rates are crucial for reliable MSCT coronary angiography in patients with suspected coronary artery disease.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease diagnosis relies on accurate imaging.
- Multislice spiral computed tomography (MSCT) is a key imaging modality.
- Heart rate variability can impact image quality and diagnostic accuracy.
Purpose of the Study:
- To assess the influence of varying heart rates on the diagnostic performance of MSCT coronary angiography.
- To determine the optimal heart rate range for reliable MSCT coronary angiography.
- To compare MSCT coronary angiography accuracy across different heart rate groups.
Main Methods:
- Prospective observational study involving 78 patients undergoing both conventional and MSCT coronary angiography.
- Patients were stratified into three heart rate groups: low (55.8 bpm), moderate (66.6 bpm), and high (81.7 bpm).
- ECG-synchronized MSCT images were analyzed for image quality, sensitivity, and specificity in detecting coronary stenoses.
Main Results:
- Image quality and diagnostic accuracy significantly decreased as heart rate increased (78% in low HR vs. 54% in high HR).
- Sensitivity for detecting significant stenoses dropped from 97% in the low HR group to 67% in the high HR group.
- Overall sensitivity, accounting for non-assessable segments, decreased substantially with higher heart rates (82% vs. 32%).
Conclusions:
- MSCT coronary angiography provides reliable diagnostic accuracy primarily in patients with lower heart rates.
- Elevated heart rates compromise the quality and accuracy of MSCT coronary angiography.
- Achieving low heart rates is essential for optimal results with MSCT coronary angiography.
Objective:
To evaluate the impact of heart rate on the diagnostic accuracy of coronary angiography by multislice spiral computed tomography (MSCT).
Design:
Prospective observational study.
Patients:
78 patients who underwent both conventional and MSCT coronary angiography for suspicion of de novo coronary artery disease (n=53) or recurrent coronary artery disease after percutaneous intervention (n=25).
Setting:
Tertiary referral centre.
Methods:
Intravenously contrast enhanced MSCT coronary angiography was done during a single breath hold, and ECG synchronised images were reconstructed retrospectively. All coronary segments of > or = 2.0 mm without stents were evaluated by two investigators and compared with quantitative coronary angiography. Patients were classified according to the average heart rate (mean (SD)) into three equally sized groups: group 1, 55.8 (4.1) beats/min; group 2, 66.6 (2.8) beats/min; group 3, 81.7 (8.8) beats/min.
Results:
Image quality was sufficient for analysis in 78% of the coronary segments in patients in group 1, 73% in group 2, and 54% in group 3 (p < 0.01). The sensitivity and specificity for detecting significant stenoses (> or = 50% lumen reduction) in these assessable segments were: 97% (95% confidence interval (CI) 84% to 100%) and 96% in group 1; 74% (52% to 89%) and 94% in group 2; and 67% (33% to 90%) and 94% in group 3 (p < 0.05). Accounting for all segments of > or = 2.0 mm, including lesions in non-assessable segments as false negatives, the sensitivity decreased to 82% (28/34 lesions, 95% CI 69% to 91%), 61% (14/23 lesions, 42% to 77%), and 32% (6/19 lesions, 15% to 50%), respectively (p < 0.01).
Conclusions:
MSCT allows reliable coronary angiography in patients with low heart rates.