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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Image quality of coronary 320-MDCT in patients with atrial fibrillation: initial experience
Sundeep S Pasricha1, Dee Nandurkar, Sujith K Seneviratne
1Department of Diagnostic Imaging, Monash Medical Centre, Southern Health, Clayton, Victoria 3168, Australia.
Insights
320-MDCT imaging is feasible in patients with atrial fibrillation, yielding diagnostic quality images for most coronary segments. The distal circumflex artery (segment 15) was most challenging due to its small size.
Area of Science:
- Cardiology
- Medical Imaging
- Radiology
Background:
- Noninvasive coronary angiography is typically contraindicated in patients with atrial fibrillation due to irregular heartbeats complicating synchronization.
- Atrial fibrillation presents challenges for cardiac imaging modalities requiring precise timing.
Purpose of the Study:
- To evaluate and compare the image quality of 320-MDCT coronary angiography in patients with atrial fibrillation versus those in sinus rhythm.
- To determine the feasibility and diagnostic quality of 320-MDCT in patients with irregular heart rhythms.
Main Methods:
- A retrospective analysis comparing 320-MDCT coronary angiography images from patients with atrial fibrillation and a control group in sinus rhythm.
- Two blinded reviewers assessed 15 coronary artery segments per patient for image quality, categorizing them as diagnostic or poor quality.
- Image quality was scored subjectively, with a focus on diagnostic acceptability.
Main Results:
- 96% of coronary artery segments in the atrial fibrillation group achieved diagnostic image quality, compared to 100% in the sinus rhythm group (p < 0.05).
- Poor image quality (score 3) was observed in 4% of segments in the atrial fibrillation group, primarily affecting the distal circumflex artery (segment 15).
- The overall mean image quality score was slightly lower in the atrial fibrillation group (1.25) than in the sinus rhythm group (1.08) (p < 0.001).
Conclusions:
- 320-MDCT coronary angiography is a viable imaging option for patients with atrial fibrillation, with most segments demonstrating diagnostic quality.
- The distal circumflex artery (segment 15) poses the greatest visualization challenge, particularly in cases of a dominant right coronary system.
- Despite minor differences in image quality, 320-MDCT offers a valuable noninvasive approach for coronary assessment in patients with atrial fibrillation.
Objective:
Noninvasive coronary angiography has generally been contraindicated in patients with atrial fibrillation because of the difficulty in synchronizing an irregular heartbeat with table gantry movement. The objective of this study was to evaluate and compare the quality of 320-MDCT images obtained in patients with atrial fibrillation and in a control group of patients in sinus rhythm.
Materials And Methods:
Two reviewers were blinded to the patient groups and evaluated images of 15 coronary artery segments for each patient using 320-MDCT. The images were printed on glossy paper and scored subjectively as 1 or 2, meaning of diagnostic quality, or 3, meaning poor quality.
Results:
No statistical difference between the groups was noted in patient age: The mean age of the patients with atrial fibrillation was 67 years (age range, 52-82 years) and that of the patients in sinus rhythm was 59 years (36-86 years) (p = 0.3). Scores of 1 and 2 (diagnostic quality) were assigned to 100% in sinus rhythm and 96% in atrial fibrillation (p < 0.05). Scores of 3 were seen only in the atrial fibrillation group (7/175, 4%). Segment 15, the distal circumflex artery, was the segment that was most frequently assigned a score of 3 (2/7, 28.6%). A discrepancy in the two reviewers' scores was seen in 25 segments (7%), requiring joint consensus. The segments that most frequently required consensus reading were segments 12 and 15. The overall mean image quality score for all three coronary arteries in atrial fibrillation was 1.25 +/- 0.47 (SD) and 1.08 +/- 0.26 in sinus rhythm (p < 0.001). The median effective dose was 19.28 and 13.55 mSv in the atrial fibrillation and sinus rhythm groups, respectively.
Conclusion:
The analysis of our initial experience shows that imaging in patients with atrial fibrillation is possible using 320-MDCT, with images of most segments obtained being of diagnostic quality. Segment 15 was the most difficult to see on 320-MDCT because of the small caliber of the vessel; poor visualization of that segment mostly occurred in the setting of a dominant right coronary arterial system.
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