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Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography
Ulrike Ropers1, Dieter Ropers, Tobias Pflederer
1Department of Internal Medicine 2 (Cardiology-Angiology), University of Erlangen-Nuremberg, Erlangen, Germany.
Insights
Dual-source CT coronary angiography shows slightly reduced image quality at higher heart rates but maintains diagnostic accuracy for detecting coronary artery stenosis. This study evaluated 100 patients without beta-blocker pre-medication.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Multidetector CT (MDCT) coronary angiography has shown an inverse relationship between heart rate and image quality.
- Dual-source CT (DSCT) offers higher temporal resolution, potentially improving image quality at elevated heart rates.
Purpose of the Study:
- To assess the impact of heart rate on image quality and diagnostic accuracy of DSCT coronary angiography.
- To determine if higher heart rates affect the ability to detect coronary artery stenoses using DSCT.
Main Methods:
- One hundred patients underwent DSCT coronary angiography with a contrast-enhanced volume dataset acquisition.
- Image datasets were evaluated for significant coronary stenoses and validated against invasive coronary angiography.
- Patients were analyzed based on heart rate: >=65 beats/min versus <65 beats/min, without beta-blocker pre-medication.
Main Results:
- Per-segment evaluability was 92% for heart rates >=65 bpm and 100% for heart rates <65 bpm (p < 0.001).
- Per-patient evaluability was 93% for heart rates >=65 bpm and 100% for heart rates <65 bpm.
- Despite slightly lower evaluability at higher heart rates, diagnostic accuracy (sensitivity, specificity) for detecting coronary stenoses did not differ significantly between heart rate groups.
Conclusions:
- DSCT coronary angiography demonstrates slightly reduced per-segment evaluability in patients with heart rates >=65 bpm.
- However, DSCT maintains diagnostic accuracy for detecting coronary artery stenoses even at higher heart rates without beta-blocker pre-medication.
Objectives:
We evaluated the influence of heart rate on image quality and diagnostic accuracy of dual-source computed tomography (DSCT) coronary angiography.
Background:
Multidetector computed tomography (MDCT) coronary angiography has demonstrated an inverse relationship between heart rate and image quality. Dual-source CT provides a higher temporal resolution.
Methods:
One hundred patients were studied by DSCT (DEFINITION, Siemens Medical Solutions, Forchheim, Germany). A contrast-enhanced volume dataset was acquired (two tubes, 120 kV, 400 mAs/rot, collimation 64 x 0.6 mm). Datasets were evaluated concerning the presence of significant coronary stenoses and validated against invasive coronary angiography.
Results:
In 44 patients with a heart rate > or =65 beats/min, 566 of 616 coronary segments were evaluable (92%), whereas in 56 patients with a heart rate <65 beats/min, 777 of 778 coronary segments were evaluable (100%, p < 0.001). On a per-patient basis, 93% of patients (> or =65 beats/min) and 100% of patients (<65 beats/min) were considered evaluable. By classifying unevaluable segments as positive for stenosis, per-patient sensitivity was 95% (19 of 20) for heart rates > or =65 beats/min and 100% (22 of 22) for heart rates <65 beats/min. Specificity was 87% (21 of 24) versus 76% (26 of 34), and overall diagnostic accuracy was 91% (40 of 44) versus 86% (48 of 56). None of these differences were statistically significant. Similarly, no difference in diagnostic accuracy was found in per-vessel and -segment analyses.
Conclusions:
In 100 patients studied without beta-blocker pre-medication, DSCT demonstrated slightly lower per-segment evaluability for high heart rates but no decrease in diagnostic accuracy for the detection of coronary artery stenoses.
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